APPLICATION FOR FUND SWITCH

Transcription

1 Policy No.: Plan Name: APPLICATION FOR FUND SWITCH CONDITIONS TO BE READ BEFORE FILLING THE FORM: 1. This form needs to be filled by the policyholder himself/herself in BLOCK LETTERS in black or blue ink. 2. In case of switching the funds from Top-Up account kindly fill in the fund switch details in the Top-Up A/C Form. 3. If this application form is received by 3.00 p.m. on a working day, switch shall be effected at the applicable price declared on the same day. 4. If the application form is received after 3.00 p.m. on a working day, switch shall be effected at the applicable price declared on the next Trading day. 5. This application will not be effective until it is officially accepted by Mahindra Old Mutual Life Insurance Limited. 6. The switch will not affect your future premium allocation, only the current holding shall be switched as per the request. 7. Two Financial Transaction cannot be processed on same day. 8. In order to abide by the Foreign Account Tax Compliance Act (FATCA), kindly submit a Insurance FATCA Declaration, separately, if the answer to any of these questions is a yes : (i) Are you a citizen of any other country apart from India (dual or multiple citizenship); (ii) Are you a resident (for tax purposes) of any other country other than India; (iii) Do you hold a green card of USA or any similar card for any other country? I/We confirm that I/we shall report any future changes in my/our tax status to Life Insurance within 30 days of such change. I/We also confirm that until I/we provide a written intimation about any such changes, Life Insurance may presume that there is no change in my/our tax residency status and consider my/our earlier submitted declarations, if any, as valid. I understand that for any queries about my/our tax residency, I/we have to consult my/our own tax consultant. Plan : Title Surname First name Middle name Date: D D M M Y Y Y Y Contact Details: ID: Do your bit for green world & Switch to e-communication. Kindly mark if you would like to receive your communication through electronic mode. FUNDS SWITCH: Please note that switching of fund changes only existing fund holdings. If you wish to change the fund allocation of future premiums, please fill the Application for Premium Re-direction form. I apply to switch the value of units held under this policy as indicated Main Account Top Up Account (In case of switching the funds from Top-Up account kindly fill in the fund switch details in the s Switch from Top-Up A/C form.) KGRG KBLG [ ] - Safe investment Plan II (KSI & K01) [ ] - Flexi Plan (KFP & K02) [ ] - Platinum Advantage Plan Shield A/c (K08) [ ] - Platinum Advantage Plus Shield A/c (K17 & K16) Guaranteed Growth Guaranteed Dynamic Bond Dynamic Floating Rate Dynamic Gilt Dynamic Frontline Equity, K16, K17 KSI, K01, K02A, K02B, K08A, K16A, K17A, KFP1, KFP3, KULO - In case of KSI, K01, K02A, K02B, K08A, K16A, K17A, KFP1, KFP3, KULO Frontline Equity is available only when the Capital Guarantee falls off. - Once Frontline Equity has been opted for, customer cannot have his Capital Guarantee reinstated at any point of time. - Dynamic is available only in the last policy year. - Guarantee & Front line Equity is not available for KSIP with product code KULO & Joint Life KSIP policies. - Platinum Adv. Plus product code K16 & K17, only Guaranteed Growth is available. GRTF [ ] - Safe investment Plan II (K34 ) [ ] - Secure Invest Insurance (K41) Frontline Equity Guarantee - Frontline Equity is available only whent he Capital Guarantee falls off. - Once Frontline Equity has been opted for, customer cannot have his Capital Guarantee reinstated at any point of time. [ ] - Priviledged Assurance ( ) KAPF KAP2 KAMF KAM2 Advantage Plus Advantage Plus II Advantage Multiplier Advantage Multiplier II Policy No. Signature of Scribe Signature of Policyholder

2 KGRP KBLP KFRP KGLP [ ] - Retirement Plans (unit-linked) (K04A, K04B & K04C) [ ] - Secure Retirement Plan (K18) [ ] - Retirement Income Plan (KRI1, KRI2, KRI3) Growth Bond Floating Rate Gilt II Frontline Equity K18 K04A, K04B, K04C, K18, KRI2, KRI3 K04A, K04B, K04C, KRI1, KRI2, KRI3 K04A, K04B, K04C, K18A, KRI1, KRI2, KRI3 - Growth is available only with Secure Retirement Plan (K18) and not available with Retirement Plans (K04A, K04B & K04C) - II is available only in the last policy year. - Frontline Equity is available in K04A, K04B, K04C, K18A, KRI1, KRI2, KRI3 [ ] - Easy Growth (KEG) [ ] - Long Life Secure Plus and Wealth Plus (K13,K14) [ ] - Headstart Future Protect and Assure Wealth (K05 & K06) [ ] - Smart Advantage (K12) [ ] - Platinum Adv Plus Dynamic A/c (K08, K16 & K17) [ ] - Single Invest (K20) Aggressive Growth Dynamic Growth Dynamic Dynamic Floating Rate Dynamic Gilt Dynamic Dynamic Bond Opportunities Dynamic From (%) To (%) Available in (For Policies issued on or prior to 31st Dec 2009) K05, K06, K08, K13, K14, K16, K17 KEG, K05, K06, K08, K12, K13, K14, K16, K17, K20 K12, K05, K06, K13, K14, K16, K17, K20 K12, K05, K06, K08, K13, K14, K16, K17, K20 - Dynamic is available only in the last policy year. - Headstart plans only for the following code (K05A, K05B, K06A, K06B, K05C, K05D, K06C & K06D). - Smart Advantage (K12) has only 3 fund option viz. Dynamic Bond (), Dynamic () & Opportunities () - Opportunities () & Dynamic () is not available in Easy Growth Plan (KEG) - Opportunities () is not available in Platinum Adv Plus Dynamic A/c (K08) - In Smart Advantage Plan there is no unit allocation in the 1st policy year. - is not available for Easy Growth (KEG). [ ] - Long Life Secure Plus and Wealth Plus (K13 & K14) [ ] - Headstart Future Protect and Assure Wealth (K05 & K06) [ ] - Single Invest (K20) From (%) To (%) Available in (For Policies issued after ) Classic Opportunities Frontline Equity Dynamic II Peak Guarantee NA - Headstart plans only for the following code (K05A, K05B, K06A, K06B, K05C, K05D, K06C & K06D). - Switch In not allowed in peak guarantee fund (Post 30th April 10), only switch out is allowed for those customers who have opted for this fund. [ ] - Headstart Future Protect and Assure Wealth (K27 & K28) [ ] - Long Life Secure Plus and Wealth Plus (K29 & K30) [ ] - Platinum Edge (K31) [ ] - Single Invest (K33) - Policies Issued after 1.Jan.10 [ ] - Wealth Insurance Plan (K38) [ ] - Super Advantage (K23) [ ] - Headstart Child Assure (K40) [ ] - Ace Investment (K42) [ ] - Single Invest Advantage (43) [ ] - Platinum (K44) Dynamic Floating Rate Dynamic Gilt Dynamic Bond Classic Opportunities Frontline Equity Dynamic II Peak Guarantee K20 NA K27, K28, K29, K30, K31, K38, K40, K42, K44 K27, K28, K29, K30, K31, K38, K40, K42, K44 K27, K28, K29, K30, K31, K33, K38, K40, K42, K43, K44 K27, K28, K29, K30, K31, K33, K38, K40, K42, K43, K44 K31, K33, K43 - Switch In not allowed in peak guarantee fund (Post 30th April 10), only switch out is allowed for those customers who have opted for this fund. - In Super Advantage (K23) there is no unit allocation in the 1st policy year. Policy No. Signature of Scribe Signature of Policyholder

3 [ ] - Second Innings Plan () Bond Opportunities [ ] - Second Innings Plan () From (%) To (%) Available In (Customers who have switched to new funds on or before 15th Mar 10) Classic Opportunities Frontline Equity II Important Points : [ ] - Second Innings Plan () [ ] - Guaranteed Builder (K24) Bond II II Frontline Equity Classic Opportunities II Guarantee & K24 1. Smart Advantage (K12) has only 3 fund option viz. Dynamic Bond (), Dynamic () & Opportunities () 2. Opportunities and Dynamic is not available in Easy Growth Plan (KEG) 3. Opportunities () is not available in Platinum Adv Plus Dynamic A/c (K08) 4. Growth is available only with Secure Retirement Plan (K18) and not available with Retirement Plans (K04A, K04B & K04C) 5. Dynamic, II and Dynamic is available only in the last policy year. 6. is not available for Easy Growth (KEG). 7. In case of Safe Investment Plan II Frontline Equity is available only when the GMV falls off. 8. Once Frontline Equity has been opted for, customer cannot have his GMV/Capital Guarantee reinstated at any point of time. 9. Gurantee & Front line Equity is not available for KSIP with product code KULO & Joint Life KSIP policies. 10. Platinum Adv. Plus product code K16 & K17, only Guaranteed Growth is available. 11. Switch is not permissible for any policy in lapsed status. switch is not allowed in notice period. 12. Switch In not allowed in peak guarantee fund (Post 30th April 10), only Switch Out is allowed for those customers who have opted for this fund. I hereby declare that I Understand and agree to all the conditions and information given above. I further agree and understand that Switch consequent to my request for the same herein shall be governed by the provisions and terms and conditions of the policy contract referred to herein. K24 Signature of Policyholder Signature of Scribe Note: In case the policy is assigned, please ensure that this form is signed by the Assignee. FOR BRANCH OFFICE USE ONLY Name of Scribe: Relationship with owner: Contact Details of Scribe: Note : Please fax Switch/Future premium re-direction form on If faxed on any other number then we will not be responsible for delay in processing. Mode of Receipt : Request Call ID : Name of BOE : Mahindra Old Mutual Life Insurance Ltd. Regn. No. 107, CIN: U66030MH2000PLC128503, Regd. Office: 4th, Vinay Bhavya Complex, 159-A, C.S.T. Road, Kalina, Santacruz (E), Mumbai For any correspondence kindly contact us at: Infiniti, 7th, Zone IV, Building No. 21, Infiniti Park, Off Western Express Highway, Goregaon Mulund Link Rd., General A.K. Vaidya Marg, Malad (E), Mumbai (+9122) {D} {F} (toll free) clientservicedesk@kotak.com BRANCH STAMP CC\PS\ Switch\003 ACKNOWLEDGEMENT We acknowledge the receipt of Switch request for Policy No.: Branch Name: Name of Branch Co-ordinator : Date : Time : Mahindra Old Mutual Life Insurance. Regn. No. 107, CIN: U66030MH2000PLC128503, Regd. Office: Mahindra Old Mutual Life Insurance Ltd., 4th, Vinay Bhavya Complex, 159-A, C.S.T. Road, Kalina, Santacruz (E), Mumbai For any correspondence kindly contact us at: Infiniti, 7th, Zone IV, Building No. 21, Infiniti Park, Off Western Express Highway, Goregaon Mulund Link Road, General A.K. Vaidya Marg, Malad (E), (toll free) Mumbai (+9122) {D} {F} clientservicedesk@kotak.com Insurance is the subject matter of solicitation. CC\PS\ Switch\003

4 Policy No Name of Policy Owner s Switch in Top Up Account Plan Name Contact Details : ID : For old policies issued on or Prior to Dec 31, 2010 FROM % to be Switched For New policy holder for policies issued post Jan 01, 2010 FROM % to be Switched Dynamic Floating Rate Dynamic Gilt Dynamic Bond Dynamic II Frontline Equity Classic Opportunities Guarantee II Bond II II Frontline Equity Classic Opportunities Guarantee Peak Guarantee * Total * Kindly check the funds available to invest the Top Up Amount from the table given and select the funds accordingly. Policy Holders Signature Scribe Signature TO % of allocation Opportunity Bond Gilt Growth Aggressive Growth Floating Rate Bond Opportunity Opportunity Bond Gilt Growth Aggressive Growth Floating Rate Bond Opportunity Total Total For old policies holders who opted to switch to new funds prior to March 15, 2010 FROM % to be Switched Dynamic II TO % of allocation Dynamic II Frontline Equity Classic Opportunities Guarantee II Frontline Equity Classic Opportunities Frontline Equity Classic Opportunities Guarantee II Frontline Equity Classic Opportunities Peak Guarantee * Total Total * Switch In for Peak Guarantee fund will be allowed only during the tranche period and for policies that have their maturity date on or after the fund maturity date. TO % of allocation Dynamic Floating Rate Dynamic Gilt Dynamic Bond Dynamic II Frontline Equity Classic Opportunities Guarantee II Bond II II Frontline Equity Classic Opportunities Guarantee Date Time D D M M Y Y Y Y H H M M Total * Switch In for Peak Guarantee fund will be allowed only during the tranche period and for policies that have their maturity date on or after the fund maturity date. * Peak Guarantee funds available only for Single Invest Plans and Platinum Edge Plans.

5 Annexure I (For information only) available for Top-Up Plan Name Product Opportunity Bond Gilt Growth Aggressive Growth Floating Rate Bond Opportunity Dynamic II Frontline Equity Classic Opportunities Guarantee II II II Frontline Equity Classic Opportu -nities Guarantee Easy Growth Plan-5 Times KEG3 Easy Growth Plan-1.25 KEG4 Safe Investment Plan - Low cover K01A Safe Investment LPP - Low cover K01B Safe Investment Plan - High cover K01C Safe Investment LPP - High cover K01D # For Old Safe Investment Plans who Opted to switch to new funds prior to March 15, 2010 K01 Flexi Plan / Flexi Plan LPP Flexi Plan (before guidelines) Retirement Plan Single Prem (Unit Linked) K02A / K02B KFP1, KFP2, KFP3, KFP4 K04A Retirement Plan With Cover (Unit Linked) K04B Retirement Plan Without Cover (UnitLinked) K04C Retirement Income Plan (Unit Linked) Single Premium (before UL guideines) KRI 1 " Retirement Income Plan - Unit Linked With Cover (before UL guidelines) Retirement Income Plan- Unit Linked Without Cover (before UL guidelines)" "KRI 2 KRI3" HeadStart Future Protect -Single Life/ Joint Life HeadStart Assurewealth-Single Life/ Joint Life K05A, K05B, K05C, K05D K06A, K06B, K06C, K06D # For Old Headstart Plans who Opted to switch to new funds prior to March 15, 2010 Platinum Advntage Shield / Dynamic / Risk K08A, K08B, K08C Plt Adv Plus Shld double / Single K17A K17B, K17C, Smart Advantage - Regular / Limited "K12A, K12B" Long Life Secure Plus - Regular/ Limited/ Inbuilt Benefit Long Life Wealth Plus - Regular / Limited "K13A, K13B, K13C" "K14A, K14B" # For Old Long Life Plans who Opted to switch to new funds prior to March 15, 2010 K13, K14 Secure Retirement Plan K18A Second Innings Plan A # For Old Second Innings Plans who Opted to switch to new funds prior to March 15, 2010 A Single Invest Plan(5xSP) K20 No Top Up New HeadStart Future Protect-Single Life/Joint Life K27, K28 New Long Life Secure Plan K29, K30 Guaranteed Builder K24 Super Advantage K23 Platinum Edge K31 New Second Innings New Safe Investment Plan II K34 Wealth Insurance Plan K38 ACE Investment Plan K42 Single Invest Plan K33 Single Advantage Plan K43 Headstart Child Plan K40 Platinum Plan K44 * Incase of Safe Investment Plan II 'Frontline Equity ' is available only when guarantee / capital guarantee falls off.