SALARY DEDUCTION FORM

Individual Life & Pensions

PLEASE CANCEL ANY PREVIOUS DEDUCTIONS IN FAVOUR OF

GUARDIAN LIFE

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.

SD- L& P v.1 NOV2014
Please complete details overleaf


SALARY DEDUCTION FORM

Individual Life & Pensions


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

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

SD- L&P v.1NOV2014
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