VOLUNTARY CLAIM FORM

VOLUNTARY CLAIM FORM
PLEASE READ THIS SECTION BEFORE YOU START COMPLETING THIS FORM.
Use this form to apply for:
- A partial withdrawal from your Voluntary Account
- A full withdrawal and closure of your Voluntary Account
Members are limited to one voluntary withdrawal per calendar year (January - December). Pensioners may only retain and withdraw from a Voluntary Account if it was established before their retirement.
SECTION 1 Member's Details
RMD Number:
CINSF Member Number:
Title
First name(s):
Surname:
Date of birth (DD/MM/YYYY)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age:
Gender:
Physical Address:
Home phone:

Country CodePhone Number
Mobile phone:

Country CodeMobile Number
Email address:
example@example.com
Final payroll contribution date (DD/MM/YYYY)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
SECTION 2 Voluntary Account Withdrawal
Withdraw part of my Voluntary Account:
Enter Amount
Withdraw my full Voluntary Account and Permanently close the account.
Enter amount
SECTION 3 Payment Details
Bank name:
Bank number:
Branch:
Branch number:
Account Number:
Account Name:
SWIFT code (overseas accounts only):
Bank address (overseas accounts only)
SECTION 4 Member Declaration and Signature
Please read the statement carefully before signing.

By signing this form, I confirm that:
a. I declare that the information and supporting documents I have provided are true, complete and correct.
b. I understand that I may make only one withdrawal from my Voluntary Account in each calendar year.
c. I understand that a partial withdrawal will leave my Voluntary Account open, while a full withdrawal will permanently close my Voluntary Account.
d. I understand that I may continue making voluntary contributions only if my Voluntary Account remains open.
e. I authorise CINSF to verify the information provided and obtain any additional information necessary to process my withdrawal.
f. I understand that providing false or misleading information may result in delays, recovery of any overpayment, or other action in accordance with the Fund Rules or applicable law.
g. I understand that my account balance remains subject to investment gains and losses until my claim has been approved.
Member signature
Date (DD / MM / YYYY)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
SECTION 6 Required Information and Documents
a. Identification
Provide only One (1) valid photo identification
- Passport
- Birth certificate with a current photo
- Drivers Licence
b. Payroll Confirmation Letter or Email:
- For a full withdrawal where Voluntary deductions are continuing:
  - Employer or payroll confirmation of the amount and frequency of ongoing voluntary contributions.
- For a full withdrawal with no further voluntary contributions:
  - Employer or payroll confirmation of the date voluntary deductions stopped.
c. Bank Account Confirmation:

One (1) bank account confirmation:

Bank confirmation letter
Bank statement (local accounts only)

Upload Required Document

Cancelof
enquiry@superfund.gov.ck
+682 25515| www.cinsf.com
PO Box 3076, Avarua, Rarotonga
Should be Empty:

VOLUNTARY CLAIM FORM

SECTION 1 Member's Details

SECTION 2 Voluntary Account Withdrawal

SECTION 3 Payment Details

SECTION 4 Member Declaration and Signature

By signing this form, I confirm that:

SECTION 6 Required Information and Documents