Surrender Declaration (RSA) RMM with MVA t&c's

CONDITIONS, DECLARATIONS AND RESTRICTIONS

•  I understand that, as a result of the current financial crisis, Old Mutual has decided to apply a market value adjuster to all policies that are surrendered. This is to protect customers who remain invested. This market value adjuster will reduce the value of my policy when I surrender. This reduction will be calculated based on the current market value adjuster percentage applied to my policy’s fund value.

• I would like to cancel the Benefit(s) and have the full surrender value proceeds, where applicable, paid to me.

• I understand that when the Long Term Pocket of my 2-IN-ONE SAVINGS Plan is surrendered, the Short Term Pocket will also be surrendered. The Long Term Pocket is the portion of your 2-IN-ONE SAVINGS Plan that aims to help you achieve your future, longer term financial goal (e.g. your children’s education or a deposit on a house). The value of the Long Term Pocket is the total of the Long Term Pocket premiums we have received, minus charges and part withdrawals you have taken, plus bonuses and Savings Boosters. The Short Term Pocket is the portion of your 2-IN-ONE SAVINGS Plan that is available to you whenever you need money. The value of the Short Term Pocket is the total of the Short Term Pocket contributions we have received, plus or minus any increase or decrease in value due to investment growth, plus any Savings Top-ups, minus any part withdrawals you have taken and minus all charges.

• I declare that I am the legal owner of the Benefit(s) and that I have not ceded or pledged the said Benefit(s) by antenuptial contract or otherwise.

• I understand that the surrender process terminates the Benefits(s), and that the surrender value is the withdrawal of the cash value of the Benefit(s).

• I understand that I am depriving myself of valuable insurance provision and that no further benefits are payable under the Benefit(s) after the effective date of the surrender.

• I am also aware and give consent that a surrender charge, where applicable, applies.

• I, the undersigned, hereby request Old Mutual to deposit the proceeds into the bank account provided and declare that the bank details provided are complete and accurate.

• I hereby absolve Old Mutual from any risk or liability resulting from the proceeds being deposited into an incorrect bank account where I supplied the incorrect bank details.

• If there is an outstanding Zero Interest Loan, this will be settled from the proceeds of the policy.

NOTE

If you pay your premiums by debit order and a premium was deducted from your account in the last nine days, we are waiting for the premium to clear at the bank. The value that is paid into your bank account will be the value quoted less the premium that hasn’t cleared yet. If the debit order clears, we will refund the premium into the same bank account the value was paid.