AUTHORITY TO A BANK TO PAY PREMIUMS FOR LIFE INSURANCE POLICY
…………………………
…………………………
Date: …………………..
To
The Manager,
…………………….Bank
…………………..Branch
…………………………
Dear Sir,
I hereby request you to pay from my Savings Bank Account No …………………………maintained with you, the premiums on the policy of Insurance No……………for Rs . ……………………with the Life Insurance Corporation of India ……………………Branch.
(i) Branch to which premium is to be paid:
(ii) Amount of premium:
(iii) Date of payment of premium:
Yours faithfully,
Pro-Formats 