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POLICYHOLDER PREAUTHORIZED DEBIT (PAD) AGREEMENT Category: BusinessGROUP INSURANCEPrintPOLICYHOLDER INFORMATIONPolicyholders name (employer/organization):___ Group policy no.: ___Division no.: All

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How to fill out policyholder pre-authorized debit pad

01

Obtain the policyholder pre-authorized debit pad from the insurance provider.

02

Fill in your policyholder information on the provided fields. This usually includes your name, address, contact details, and policy number.

03

Specify the bank account information from which the premium payments will be deducted. This may include the bank name, branch address, transit number, and account number.

04

Sign and date the authorization form, indicating your consent for the insurance provider to debit premiums from your specified bank account.

05

Keep a copy of the filled-out form for your records.

06

Submit the completed pre-authorized debit pad to your insurance provider as instructed, either via mail, fax, or in-person.

Who needs policyholder pre-authorized debit pad?

01

Policyholders who prefer a convenient and automated method of paying their insurance premiums.

02

Those who want to ensure timely payment of premiums without the hassle of manual payments.

03

Individuals who want to avoid the risk of missing payments and potential policy cancellation.

04

Policyholders who have an active bank account and are comfortable authorizing automatic withdrawals.

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What is policyholder pre-authorized debit pad?

Policyholder pre-authorized debit pad is a form used by policyholders to authorize automatic payments from their bank account for insurance premiums.

Who is required to file policyholder pre-authorized debit pad?

Policyholders who wish to set up automatic payments for their insurance premiums are required to file policyholder pre-authorized debit pad.

How to fill out policyholder pre-authorized debit pad?

Policyholders can fill out the policyholder pre-authorized debit pad by providing their bank account information, authorization signature, and any other required information requested by the insurance company.

What is the purpose of policyholder pre-authorized debit pad?

The purpose of policyholder pre-authorized debit pad is to simplify the payment process for policyholders by allowing automatic deductions from their bank account for insurance premiums.

What information must be reported on policyholder pre-authorized debit pad?

Policyholder pre-authorized debit pad must include the policyholder's bank account information, authorization signature, and any other information required by the insurance company.

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