Generali Worldwide Partial Surrender Request - …

1 of 3 | Generali Worldwide Insurance Company Limited Partial Surrender RequestGW PART SURR REQ 12/15 Generali Worldwide Partial Surrender RequestPLEASE COMPLETE THIS FORM USING BLOCK CAPITALS. ALL SECTIONS ARE MANDATORY UNLESS INDICATED 1 Planholder DetailsPlan No(s) _____1st Planholder _____2nd Planholder_____Section 2 Surrender DetailsGenerali Worldwide Insurance Company Limited can make payment in a currency other than the plan currency if you Request us to do so. Any applicable cost of payment (including currency exchange charges) will be deducted from the amount payable. The foreign currency exchange risk associated with Generali Worldwide Insurance Company Limited facilitating such a Request will be borne by tick the currency required, if left unticked the payment will be made in plan USD n GBP n EUR n HKD n JPY n SGDn Amount to be deducted across all investment options: _____orn Amount to be deducted from specific investment options:Investment Option* Approximate Value^Number of Units^* Please see Important Notes^ Specify either approximate value (including currency) or number of units but not both.

2 of 3 | Generali Worldwide Insurance Company Limited – Partial Surrender Request GW PART SURR RE 12/15 Section 3 – Payment Details Generali Worldwide Insurance Company Limited will not authorise third-party payments, and will only make payment to a bank

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