Pension Fund Switch Form - Aviva

Pension Fund Switch FormPolicy Number(s) / Scheme Number(s)Policy Owner / Member NameI/We wish to transfer/redirect units attaching to the above policy(ies) from the existing fund(s) to the new fund(s) ofmy/our choice as indicated below.I/We understand that the switch will be made on a Bid Price to Bid Price basis, at the bid price declared at the closeof business on the date of receipt of this request by Aviva Life & Pensions Ireland Limited, subject to conditionsoutlined in the policy document. Please note that this does not apply to the Secure Capital Fund and/or funds thatare currently subject to a deferral period. Please note that your switch request may be subject to a fund switchcharge. Please contact Aviva for more information on this.I/We understand that in the event of an incomplete or invalid fund selection, or where I/We have not submittedthe required authorised signature(s), then a new request form will be required subject to the conditions stated inparagraph two above.1. Existing FundExisting Fund Name% New Fund Name%2. Future PremiumsExisting Fund Name% New Fund Name%Policy Owner/Scheme Trustee SignatureDate/ /

Aviva Life & Pensions Ireland Limited. A private company limited by shares.Registered in Ireland No. 252737 Registered Office One Park Place, Hatch Street, Dublin 2.Member of the Irish Insurance Federation. Aviva Life & Pensions Ireland Limited is regulated by the Central Bank of Ireland.Life & Pensions One Park Place, Hatch Street, Dublin 2. Phone (01) 898 7000 Fax (01) 898 7329www.aviva.ieTelephone calls may be recorded for quality assurance purposes.3.126.12.12