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Protective Life & Annuity Insurance Company Life and Health Insurance Administration P.O. Box 12687 Birmingham, AL 352026687 PREAUTHORIZED WITHDRAWAL AGREEMENT FOR DRAFTING OF MONTHLY PREMIUM PAYMENTS

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How to fill out pre-authorized withdrawal form-pliac svc-117-pla

01

To fill out the pre-authorized withdrawal form-pliac svc-117-pla, follow these steps:

1.1

Begin by entering your personal information in the designated fields. This may include your name, address, contact number, and email address.

1.2

Next, provide the necessary details of your banking information. You may need to include your bank's name, branch number, account number, and transit number.

1.3

Indicate the amount and frequency of the withdrawal. Specify if it will be a one-time withdrawal or if it will occur on a recurring basis (weekly, monthly, etc.).

1.4

If applicable, include any additional instructions or comments in the provided space. This can be useful if you have specific requirements or requests related to the withdrawal.

1.5

Review all the information you have entered to ensure accuracy. Make any necessary corrections before proceeding.

1.6

Sign and date the form in the designated areas to confirm your consent for the pre-authorized withdrawal.

02

The pre-authorized withdrawal form-pliac svc-117-pla is typically needed by individuals who wish to authorize a specific organization or service provider to withdraw funds directly from their bank account. This could be used in various scenarios, such as:

2.1

Paying bills: If you want to automate your bill payments and have the funds deducted directly from your bank account, you may need to fill out this form for the respective service providers.

2.2

Membership fees: Some organizations may require members to provide pre-authorized withdrawal authorization to automatically deduct membership fees from their bank accounts.

2.3

Loan repayments: Lenders may request this form to establish a direct debit from your bank account for the repayment of loans or installments.

2.4

Insurance premiums: Insurance companies often offer the option to set up automated premium payments through pre-authorized withdrawal.

2.5

Charitable donations: If you wish to regularly donate a specific amount to a charitable organization, you may need to complete this form to authorize the withdrawals.

It is important to note that the specific requirements and purposes for using the pre-authorized withdrawal form can vary depending on the organization or financial institution involved.

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