• Withdrawal by Contract Worker Claim Form

  • BEFORE YOU BEGIN

  • Use this form to apply for withdrawal of your CINSF benefits if your employment in the Cook Islands was under a contract of employment and one of the following applies:

    • Contract employment of less than 3 years: You must complete a 6-month stand-down period.
    • Contract employment of 3 years or more with no Approved Scheme: You must complete a 5-year stand-down period.

    When does the stand-down period start?

    Your stand-down period begins from the date you depart the Cook Islands after completing your contract employment.

    You must complete the applicable stand-down period before submitting your claim.

    Example: If you are subject to the 6-month stand-down period and depart the Cook Islands on 1 January, you may submit your claim after completing 6 months from your departure date. Your claim must include evidence confirming your departure from the Cook Islands and all other required supporting documents.

    All withdrawals are subject to the eligibility requirements of the CINSF Trust Deed and Fund Rules and the required approval process.

  • SECTION 1 Member details

  • Title*
  • Date of birth (DD/MM/YYYY)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  •  -
  •  -
  • Date of departure from the Cook Islands (DD/MM/YYYY)*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Final payroll contribution date (DD/MM/YYYY)*
     - -
    2 digit day, 2 digit month, 4 digit year

  • SECTION 2 Payment details

  • Payment will be made only to the bank account confirmed by the supporting bank document provided with this claim.

  • SECTION 3 Member declaration and signature

  • Please read the statement carefully before signing.

    By signing this form, I confirm that:

    a) The information and supporting documents I have provided are true, complete and correct to the best of my knowledge.

    b) I understand the eligibility requirements and applicable stand-down period for a Contract Worker withdrawal.

    c) I understand that my account balance may change due to investment gains or losses until my claim is approved and processed.

    d) I authorise CINSF to verify the information provided in this form and to obtain any additional information reasonably required to assess and process my claim.

  • e) I understand that providing false or misleading information may result in delays, recovery of any overpayment, or other action in accordance with the CINSF Trust Deed, Fund Rules, or applicable law.
  • Date (DD / MM / YYYY)
     - -
    2 digit day, 2 digit month, 4 digit year

  • SECTION 4 Required information and documents

  • CINSF cannot process your claim until all required information and supporting documents have been provided. Tick each item to confirm it is attached.

  • A. COMPLETED CLAIM FORM

  • B. IDENTIFICATION

  • Provide one valid form of photo identification:

  • C. EMPLOYER CONFIRMATION

  • Provide a letter from your employer confirming:

  • D. CONFIRMATION OF DEPARTURE

  • Provide one of the following:

  • E. BANK ACCOUNT CONFIRMATION

  • Provide one document confirming the bank account stated in Section 2:

  • Submit in person, by email to enquiry@superfund.gov.ck, or by post to PO Box 3076, Avarua, Rarotonga

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