01 Personal Details


The information given will be used to contact you to confirm your request and update you on its status.

02 Request Details

Use this option to obtain a loan secured by your policy’s cash value.

Use this option to withdraw dividends on deposit credited to the policy.
Use this option to obtain funds from your Universal Life policy or Premium Deposit Account.
Use this option to obtain a refund of excess funds on your policy.

 

I hereby request a policy loan, subject to the loan provisions of the policy. If the amount requested is not available, the maximum amount available should be provided to me. I authorize Colina to apply the $20.00 fee for this transaction as an incremental loan against this policy.
I hereby request to withdraw the funds from this policy’s dividends on deposits. If the amount requested is not available, the maximum amount available should be provided to me.
I hereby request to encash/withdraw the funds from this policy. If the amount requested is not available, the maximum amount available should be provided to me.
I hereby request to have a refund from the excess funds on this policy. If the amount listed is not available, the maximum amount available should be provided to me.
 

03 Declaration of Bahamian/ Foreign Status

The Foreign Account Tax Compliance Act (FATCA) is a United States of America law requring Foreign Financial Institutions (FFIs), and Non-Financial Foreign entities (NFFE) to identify U.S account holders, as well as any en- tities that are under American control. In order to facilitate the reporting requirements,The Government of The Bahamas requires financial entities, including insurance companies, to provide details on any “yes” responses.

For more information, visit: http://www.taxreporting.finance.gov.bs/fatca/

04 Summary

Thank you for your request. A Colina representative will contact you within 1 business day regarding this request. Please ensure that you have your policy number and/or the reference number readily available.

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