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,