Please pay to GUARDIAN LIFE OF THE CARIBBEAN LIMITED, #1A Guardian Drive, Westmoorings
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