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Title	Description	Insurer	Market	Language	Product	Process	Excerpt
Residenza e Comunicazioni	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Residenza e Comunicazioni ULU PCON1527
Richiesta di Modifica della Maggiorazione in caso di Decesso	Use this form to request a change of life cover – Italy (Branch)	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of life cover – Italy (Branch) Operational Forms Richiesta di Modifica della Maggiorazione in caso di Decesso ULU PCON1317
Atto di Variazione del Fondo Interno Dedicato	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Atto di Variazione del Fondo Interno Dedicato ULU PCON1310
Richiesta Cambio Contraente Persona Giuridica	Use this form to request a change of Policyholder – Corporate Entity – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of Policyholder – Corporate Entity – Italy Operational Forms Richiesta Cambio Contraente Persona Giuridica ULU PCON1246
Richiesta Cambio Contraente Persona Fisica	Use this form to request a change of Policyholder – Physical Person – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of Policyholder – Physical Person – Italy Operational Forms Richiesta Cambio Contraente Persona Fisica ULU PCON1245
Dichiarazione di Smarrimento	Form to be used to declare the loss of policy documents – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Form to be used to declare the loss of policy documents – Italy Operational Forms Dichiarazione di Smarrimento ULU PCON1244
Richiesta Cambio Intermediario	Use this form to request a change of Intermediary – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of Intermediary – Italy Operational Forms Richiesta Cambio Intermediario ULU PCON1243
Richiesta Cambio Beneficiario	Use this form to request a change of Beneficiary – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to request a change of Beneficiary – Italy Operational Forms Richiesta Cambio Beneficiario ULU PCON1213
Costi amministrativi addizionali	Annex showing the activity-based charging grid	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Annex showing the activity-based charging grid Operational Forms Costi amministrativi addizionali ULU CONT3183
Dichiarazione di Possesso della Qualifica di “Non-U.S. Person”	Use this form to declare a status of “Non-U.S. Person”	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Use this form to declare a status of “Non-U.S. Person” Operational Forms Dichiarazione di Possesso della Qualifica di “Non-U.S. Person” ULU CONT2364
Conferma dei dati di contatto del cliente utilizzati per la firma elettronica dei documenti	Confirmation of Client contact details used for the Electronic Signing of documents	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	Non Product Specific		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Conferma dei dati di contatto del cliente utilizzati per la firma elettronica dei documenti ULU CONNECT1058
Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten	Confirmation of Client contact details used for the Electronic Signing of documents	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	Non Product Specific		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten ULU CONNECT1049
Confirmation des coordonnées du Client utilisées pour la signature électronique des documents	Confirmation of Client contact details used for the Electronic Signing of documents	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	Non Product Specific		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1048
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4269
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4257
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4245
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2600
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2597
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2594
FATCA Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Autocertificazione (FOE) ULIT CONT2170-3
Dichiarazione di Scelta di Legge / Choice of Law (FOE)	Use this form to perform a choice of law	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN), Italian (IT)	Non Product Specific		Use this form to perform a choice of law Operational Forms Dichiarazione di Scelta di Legge / Choice of Law (FOE) ULIT CONT1795
Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds ULBE PCON1561
Modification des caractéristiques principales d’un Fonds Interne Dédié existant	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’un Fonds Interne Dédié existant ULBE PCON1560
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULBE PCON1530
Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen ULBE PCON1529
Aanstelling van Tussenpersoon	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Use this form to request an appointment or change of broker Operational Forms Aanstelling van Tussenpersoon ULBE PCON1430
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULBE PCON1429
Benoeming van Begunstigden	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Use this form to nominate beneficiaries Operational Forms Benoeming van Begunstigden ULBE CONT4383
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULBE CONT4382
Select Client Policy – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Select Client Policy	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds ULBE CONT3787
Select Client Policy – Caractéristiques principales du (family shared) Fonds interne dédié	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Select Client Policy	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy – Caractéristiques principales du (family shared) Fonds interne dédié ULBE CONT3786
Select Client Policy (Multi-Support) – Fonds Interne Dédié additionnel	Annex to add additional Internal Dedicated Funds to the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Select Client Policy	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy (Multi-Support) – Fonds Interne Dédié additionnel ULBE CONT3635
Select Client Policy (Multi-Support) – Bijkomend Intern Toegewezen Fonds	Annex to add additional Internal Dedicated Funds to the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Select Client Policy	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy (Multi-Support) – Bijkomend Intern Toegewezen Fonds ULBE CONT3634
Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch)	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN), French (FR)	Non Product Specific		Request for Professional Client Status Operational Forms Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch) ULBE CONT3209
Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch)	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL), English (EN)	Non Product Specific		Request for Professional Client Status Operational Forms Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch) ULBE CONT3208
Keuze van de Toepasbare Wet / Choice of Law	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL), English (EN)	Non Product Specific		Use this form to perform a choice of law Operational Forms Keuze van de Toepasbare Wet / Choice of Law ULBE CONT3196
Choix de la Loi Applicable / Choice of Law (Branch)	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN), French (FR)	Non Product Specific		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law (Branch) ULBE CONT3195
Overzicht van bijkomende administratieve vergoedingen	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Annex showing the activity-based charging grid Operational Forms Overzicht van bijkomende administratieve vergoedingen ULBE CONT3181
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Annex showing the activity-based charging grid Operational Forms Aperçu des frais administratifs additionnels ULBE CONT3182
FATCA Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Self-Certification ULBE CONT2826
FATCA Auto-certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Auto-certification ULBE CONT2825
FATCA Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Zelfcertificering ULBE CONT2824
Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch)	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch) ULBE CONT2805
Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch) ULBE CONT2801
Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch)	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Annex to the application form for beneficiary acceptance Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch) ULBE CONT2804
Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch) ULBE CONT2800
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch) ULBE CONT2796
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch) ULBE CONT2795
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch) ULBE CONT2794
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2793
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2792
Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch) ULBE CONT2789
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2791
Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch) ULBE CONT2788

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