Fillable CREDIT AND DEBIT CARD MANDATE (RL360)

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CREDIT AND DEBIT CARD MANDATE (RL360)

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The CREDIT AND DEBIT CARD MANDATE (RL360) form is 2 pages long and contains:

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Country of origin: UK
File type: PDF

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1
WHO IS THIS FORM FOR?
This form is for plan owners who
wish to pay by credit or debit card.
You can also use this form to tell us
about a new card if your old one is
about to expire. Depending on the
type of plan you hold, this payment
option may not be available for
specific payment frequencies,
please check your plan literature or
contact us before completing.
COMPLETING THIS FORM
In order to comply with the Isle
of Man Insurance (Anti-Money
Laundering) Regulations 2008, we
may require additional source of
wealth evidence subject to where
the bank that issued your credit
or debit card is registered. For
further information about country
tiers please refer to our source
of wealth information document
available online at
www.rl360.com/
sourceofwealth.pdf
.
If you need help completing this
form please contact our Customer
Services Team on +44 (0)1624
681682 or alternatively you can
email csc@rl360.com.
WHEN YOU HAVE COMPLETED
THIS FORM
Please send the completed
instruction to premiums@rl360.
com or alternatively you can post
this to: Premiums Team, RL360,
International House, Cooil Road,
Douglas, Isle of Man, IM2 2SP,
British Isles.
IMPORTANT
We are only able to accept credit or
debit cards where the card displays
one of the logos above and is
prefixed with a ‘3’, a ‘4’ or a ‘5’.
Please note that if you own a
Quantum Malaysia or Regular
Savings Plan Malaysia, you will not
be able to make payments using
American Express. If you own a
LifePlan Lebanon plan, you will not
be able to make payments using
American Express or JCB.
We regret that we cannot accept
payments from Rand or Zimbabwe
dollar denominated cards.
The maximum amount that can
be collected by credit card is
GBP99,999.99 (or currency
equivalent) per payment.
Please make sure you allow 5
working days for your request to
be processed.
We will also require 5 working days
to process any cancellations or
amendments to your card details.
CREDIT CARD
PRE‑AUTHORISATION
Pre-authorisation is the process
of pre-approving payments with
your card provider. We carry out
this process to make sure that
the card’s details are correct
and working properly prior to
collecting your payment.
This process will create a
pre-authorisation on your credit
card for one unit in the same
currency as your plan i.e. GBP1.00/
USD1.00/EUR1.00 etc. This amount
may not appear on your credit
card statement, but will aect the
card balance or spending limit until
your card provider removes it.
If you have opted to receive text
messages from your card provider,
you may get a confirmation text
for this transaction.
PRIVACY POLICY
Our full privacy policy can be
viewed at www.rl360.com/
privacy or can be obtained by
requesting a copy from our
Data Protection Ocer.
CREDIT AND
DEBIT CARD
MANDATE
2
CREDIT AND DEBIT CARD MANDATE
RL360 plan reference
Plan owner(s)
I authorise you, until further notice in writing, to collect payments as detailed below:
Payment currency
GBP USD
EUR CHF
AUD
HKD
JPY
Payment amount
in figures
Payment amount
in words
Payment frequency
Monthly
Quarterly
Half-yearly
Yearly
Payment
commencement
date (dd/mm/yyyy)
Card type Mastercard/Eurocard
Visa
JCB
American Express*
* The amount we collect from your card will be 1% higher than your payment to cover additional charges
applied by American Express.
Card issued by
(name of bank)
Country of card issue
Cardholder’s name(s)
(must be a plan owner)
Cardholder’s address
(as held by the card
issuer)
Card number
- - -
Expiry date (mm–yy)
-
I understand that RL360 Insurance Company Limited (RL360) will advise me of the amount to be paid and the dates on which
payment is due and that RL360 may only change these after giving me prior notice.
I understand that this authority in favour of RL360 will remain in force until such time as I cancel it in writing.
Signature of
cardholder(s)
Date (dd/mm/yyyy)
RL166i 04/19
RL360 Insurance Company Limited. Registered Oce: International House, Cooil Road, Douglas,
Isle of Man, IM2 2SP, British Isles. Registered in the Isle of Man number 053002C. RL360
Insurance Company Limited is authorised by the Isle of Man Financial Services Authority.
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CREDIT AND DEBIT CARD MANDATE (RL360)

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Completed 21 June 2021

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