Policy No. - chinalife.com.hk

1 PS-FIN02/201707 of 3 __ ___ 313 22 22/F, CLI Building, 313 Hennessy Road, Wan Chai, HK Tel: 2545 8111 Fax: 2544 4395 _____ Request for Policy Maturity Form Policy No. The expression the Company used in this form refers to China Life Insurance (Overseas) Company Limited. Insurance Intermediary s Information Insurance Intermediary s Name 1. / / Branch/Intermediary s Code/ Registration Code 1. Mobile No. 1. 2. 2. 2. Part 1 Policy Information Name of Insured ( ) (If the Insured is different from the Policyholder, please complete this part.) Name of Policyholder Last Name First Name Last Name First Name Part 2 Important Notes 1. The maturity amount will be paid only on or after the maturity The specimen signature of Policyholder must match our Company s ( ) ( ) Please submit identity document(s) of Policyholder and bank account details ( bank book front page or relevant document(s)that can show the name of bank account holder and bank account no.)

2 (if apply direct payment) to process this application. Part 3 Payment Instruction ^ Policy Currency HKD^ If no specific indication, payment will be issued in the Policy currency. Part 4 Payment Methods Reinsured Application / Application New Policy no. : _____ Amount of Maturity Value to be transferred to the new Policy Full Amount Designated Amount _____ Remaining Balance : _____ Payment method of remaining balance Deliver cheque to my Insurance Intermediary Pick up cheque at Branch in person / Branch name/code:_____ / Pick up cheque at Customer Service Centre in person or by the authorized person Mail cheque to the correspondence address registered in the Company ( ) Deposit to designated local bank account (Please fill in Part 5 Direct Payment Application) ( ) Deposit to designated overseas bank account by Telegraphic Transaction (Please fill in Part 5 Direct Payment Application) ( ) Others (Please specify).

3 _____ PS-FIN02 PS-FIN02/201707 of 3 ( ) Part 4 Payment Methods (Continue) ( ) Cheque Payment (We will issue a crossed cheque in the name of policyholder) Deliver cheque to my Insurance Intermediary Pick up cheque at Branch in person / Branch name/code: _____ / Pick up cheque at Customer Service Centre in person or by the authorized person Mail cheque to the correspondence address registered in the Company ( ) Deposit to designated local bank account (Please fill in Part 5 Direct Payment Application) ( ) Deposit to designated overseas bank account by Telegraphic Transaction (Please fill in Part 5 Direct Payment Application) ( ) Others (Please specify):_____ Part 5 Direct Payment Application 1. Bank account holder must be the Policyholder. 2. Please submit copy of bank book front page or relevant document(s) that can show the name of bank account holder and account 3.

4 For overseas bank account, please provide overseas bank address, SWIFT code, overseas contact number and correspondence address of bank account holder. Bank charge of Telegraphic Transaction would be deducted from the payment amount. 4. The direct payment application is for this payment only. 5. If there is insufficient information to identify the ownership of bank account or direct payment is fail for any reason, the payment will be mailed to the policyholder in cheque. 6. CRS - If the country of remittance does not match the tax residence record, please also submit CRS Self Certification . Name of bank Account No. ( ) ( ) Name of bank account holder (Chinese) (Policyholder Only) ( ) ( ) Name of bank account holder (English) (Policyholder Only) ( ) Bank address (applicable for Telegraphic Transaction) ( ) SWIFT code (applicable for Telegraphic Transaction) ( ) Overseas contact no.

5 Of bank account holder (applicable for Telegraphic Transaction) ( ) Overseas correspondence address of bank account holder (applicable for Telegraphic Transaction) PS-FIN02/201707 of 3 Part 6 Declaration and Authorization / / / 1. 2. 3. ( ) 4. / ( ) ( ) 615 / ( ) / ( ) I/We hereby request the above application(s) be effected and declare that all statement, information and particulars given herein are accurate, true and complete and are given to the best of my/our knowledge and belief and no material information has been withheld in relation to this request. I/We agree that such change(s) or service(s) will not take effect unless all of the following conditions are met and approve by the Company.

6 1. All required payment and complete supporting documents have been submitted to the Company. 2. The request is accepted and approved by the Company during the lifetime and continued insurability of the Insured. 3. The information and statement made in this request and in other documents as required by the Company shall form the basis for this Policy alteration request and form a part of the Policy (ies) unless otherwise specified. 4. I/We provide valid documentation proofs (such as identity document and address proof) to the satisfaction of the Company for the Company to conduct due diligence on myself/ourselves, the ultimate beneficial owner of the Policy (if any) and my/our authorized signatory(ies) (if applicable) pursuant to the Anti-money Laundering and Counter-Terrorist Financing (Financial Institutions) Ordinance, Cap. 615. Part 7 Personal Information Collection Statement / (" ") I/We confirm that I/We have read and understood the Personal Information Collection Statement ("PICS") of China Life Insurance (Overseas) Company Limited.

7 For the latest version of the PICS, it can be downloaded from or is made available upon request. Part 8 Signature Signature of Policyholder _____ / _____ / _____ /DD /MM /YYYY ( ) Signature of Assignee (if applicable) _____ / _____ / _____ /DD /MM /YYYY Name & Signature of Witness _____ / _____ / _____ /DD /MM /YYYY Remarks: 1. / ( ) 30 This application must be received by our Company within 30 days from sign date of Policyholder and /or Assignee (if applicable). 2. Please read all items carefully and check that you have completed all the information on this application form before you sign your name below. Please do not sign on blank form. (852) 399-95519 313 22 If you have any queries, please feel free to contact your insurance intermediary or our Customer Service Hotline at (852) 399-95519 for details.

8 Completed form should be sent to Customer Service Department, China Life Insurance (Overseas) Co. Ltd., 22/F, CLI Building, 313 Hennessy Road, Wan Chai, Hong Kong.