SINGLE PREMIUM

BANKER’S ORDER FORM

(Please pay to GLOC's RBC account 100004013360602)

Scotiabank (Please use Scotia's Form ONLY)

COMPANY TO QUOTE UNDERMENTIONED INFORMATION WHEN MAKING PAYMENT

Kindly note that Scheduled Lumpsums, as with other Unscheduled Payments, are not reflected in your policy contract. As such, your copy of this Form serves as Guardian Life’s acknowledgement of your instructions to allocate your payments when received accordingly

Single Premium BO v.7JUN2016
Please complete details overleaf


SINGLE PREMIUM

BANKER’S ORDER FORM


LIST OF POLICIES OWNER’S NAME PREMIUM
AMOUNT
LOAN/ SUNDRY
AMOUNT
UNSCHEDULED
LUMPSUM AMOUNT
TOTAL AMOUNT
$
$
$
$

Kindly note that Scheduled Lumpsums, as with other Unscheduled Payments, are not reflected in your policy contract. As such, your copy of this Form serves as Guardian Life’s acknowledgement of your instructions to allocate your payments when received accordingly

Single Premium BO v.7JUN2016
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