Exercise Early Maturity Option Annuity Optional Maturity Date Change / Request for ProceedsPlease Select Policy Type*ERAURARAPPolicy No.*ERA Policy Number onlyPolicy No.*URA Policy Number onlyPolicy No.*RAPSalutationMr.Miss.Mrs.Dr.First Name*Middle NameLast Name*Contact No.Email Maturity Proceeds*Request for maturity proceedsRequest for date d changePlease select whether you are requesting Change of Maturity Date or Maturity ProceedsAre you in possession of the policy contract?*YesNoMaturity Option*Request for Maturity ProceedsRequest Change of Retirement AgePlease select whether you are requesting Change of Maturity Date or Maturity ProceedsChange of Retirement Age Type*CorrectionChange of Retirement AgePlease select whether you are correcting information on prior request or Changing of Maturity DatePlease select current Maturity Date* Date Format: DD slash MM slash YYYY Your selected date is in the future. Please note that airslate slate will be put on pending until maturity date. Early Maturity InformationPlease enter your date of birth* Date Format: DD slash MM slash YYYY Please select desired Maturity Date* Date Format: DD slash MM slash YYYY Date Selected Should Only Be First (1st) of the MonthPlease select desired Maturity Date(old) Date Format: DD slash MM slash YYYY BIR Number*Identification Type*Driver's PermitNational IDPassportIdentification Number*Maturity Proceeds InformationI hereby request the following optional method to receive the maturity benefit on the above-stated Policy :Optional Method of Recieving Annuity Maturity Benefit*PensionableLumpsumOnly if the expected monthly pension is less than five hundred dollars ($500.00), the full accumulation (lump sum) is payable, in accordance with Section 28(7)(b) of the Income Tax Act.Pensionable Options*Full Benefit on PensionReduced Benefit ( Tax Free Lump Sum 25 % )Select Pension Option*Select Pension OptionLife - An Annuity payable during the lifetime of the Annuitant, but without any Guaranteed period of Payment.5 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for five (5) full years10 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for ten (10) full years15 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for fifteen (15) full yearsPlease enter the following DetailsAddress 1Address 2Town/City*CountryCountryTrinidad and TobagoAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePlease select your preferred method of payment*ChequeDirect DepositName of Institution*First Citizens Bank Ltd.RBC Bank Ltd.Republic Bank Ltd.Scotiabank T&T Ltd.JMMB BankIntercommercial BankCredit Union/OtherBranch of Account*Other/Credit Union*Account number*SigningBranch of Request/CSR*Branch of RequestClaudia Benjamin-Edwards (San Fernando)Darah Maynard-Daniel (Tobago)Sharon George (Port of Spain)Karen Robinson (Port of Spain)Stacy-Leigh Muhammad (Arima)Liluatie Dwarika (Chaguanas)Preferred Branch to Collect Payment*Preferred BranchSan FernandoChaguanasArimaTobagoPort of SpainPreferred Branch to Collect Endorsement*Preferred BranchSan FernandoChaguanasArimaTobagoPort of SpainAdditional CommentSignature of Policyholder*Type-in SignatureDigital SignatureSignature*Signature*Date* Date Format: MM slash DD slash YYYY
