Retirement Claim Form

Retirement Claim Form

Retirement | Early Retirement Before completing this form, please contact CINSF to obtain your personalised pension estimate. This will help you compare the Joint Life and Single Life Pension options before making your selection. Complete all applicable sections of this online form.
Type of Benefits
1. Member Details
Type of Benefit - Select ONE of the follow option:
RMD Number
CINSF Member Number
Title
First name(s)
Surname
Residential address
Date of birth

DayMonthYear
Date
Sex at birth
Home phone

Area CodePhone
Mobile phone

Area CodePhone
Email address
example@example.com
Final payroll contribution date

DayMonthYear
Date
For Current Employer
Enter the name of your current employer. Leave blank if you are not currently employed.
2. Your Account Balances
Compulsory balance (NZ$)
Voluntary balance (NZ$)
3. Your Retirement Benefit Choices

Tick one option under 3A, 3B and 3C
3.A - If balance is Less than NZD$60,000

How would you like to receive your Compulsory balance?
Select an option
If Partial Withdraw is selected: Enter the percentage;
3.B If balance is NZD$60,000 or more

You have the options to take up to 25% lump sum and remaining balance is convert into a pension account.
If Partial Withdrawal is selected: Enter percentage
3.C Voluntary Account (optional)

Do you want to withdraw money from your voluntary account?
3C – Voluntary account option
3C – Withdraw part of voluntary account amount (NZ$)
3D – One-time top-up choice
3D – Top-up amount (NZ$)
4. Pension Quote and Selection

Contact the CINSF Office First before selecting your pension type.
Pension Type Selection
If you choose Joint Life Pension, please provide your Spouse details:
Spouse full legal name

First NameLast Name
Spouse date of birth

DayMonthYear
Date
5. Payment Details
Bank name
Bank number
Branch
Branch number
Account number
Account Name
SWIFT code (Overseas accounts only)
Bank address (overseas accounts only)
6. Member Declarations and Signature
Please read the statement carefully before signing.

By signing this form, I confirm that:
1. I have received a personalised pension quotation and understand the retirement options available to me.
2. I have had the opportunity to ask questions and have made my pension selection voluntarily.
3. I understand that once my first pension payment has been processed, my pension option cannot be changed.
4. If I have selected the Joint Life Pension, I understand my eligible spouse will continue receiving my pension after my death. If I have selected the Single Life Pension, I understand no pension will be payable to my spouse after my death.
5. If I have elected to make a one-time compulsory account top-up, I understand it must be received before my claim is approved, will permanently increase my pension, and cannot be withdrawn once my pension has commenced.
6. I understand that my pension is calculated using my final approved account balance, my age at retirement and the Fund's approved pension conversion factors. My account balance remains subject to investment gains and losses until my retirement claim has been approved.
7. I declare that the information and supporting documents I have provided are true and correct. I authorise CINSF to verify this information where necessary to assess my entitlement.
8. I understand that my retirement benefit is administered in accordance with the Cook Islands National Superannuation Fund Act, the Trust Deed and the Fund Rules, and that these governing documents prevail where applicable.
9. I understand that providing false or misleading information may result in delays, recovery of overpayments or other action in accordance with the Fund Rules or applicable law.
Member signature
Member signature date

DayMonthYear
Date
File Upload or email documents to enquiry@superfund.gov.ck

Cancelof
Should be Empty:

Retirement Claim Form

1. Member Details

2. Your Account Balances

3. Your Retirement Benefit Choices

4. Pension Quote and Selection

5. Payment Details

6. Member Declarations and Signature