WHO IS THIS FORM FOR?
This form is for policyholders who wish to send a premium payment to us by telegraphic transfer. Depending on the type of
policy you hold, this payment option may not be available for speciﬁc payment frequencies, please check your policy literature
or contact us before completing.
You should use this form if you hold:
• a RL360 policy except Protected Lifestyle Lebanon and any policy taken out whilst resident in Hong Kong
• an old Scottish Life International policy except Protected Lifestyle Lebanon
• an old Scottish Provident International policy except those taken out whilst resident in Hong Kong
For all Protected Lifestyle Lebanon policies, please use the Telegraphic transfer instruction – Protected Lifestyle Lebanon
(reference number RL180).
For RL360 and old Scottish Provident International policies taken out whilst resident in Hong Kong, please use the Telegraphic
transfer instruction – Hong Kong (reference number RL179).
If you are resident in the United Arab Emirates, you are welcome to use the accounts detailed in this form. Alternatively, you may
wish to pay premiums into a local account, in which case please use the Telegraphic transfer instruction – United Arab Emirates
(reference number RL185).
COMPLETING THIS FORM
The form is split into 2 sections:
This is where you instruct your bank that you would like to debit an amount of money from your account in relation to your
policy. You must complete this section in full, making sure that all policyholders, trustees or authorised signatories sign.
Where applicable, please ensure that the authorised signatory list(s) that we hold for your policy are up-to-date before
submitting instructions. Where authorised signatories have changed and we are unable to match those on this form with our
records, this will cause a delay. We may also request further information for the purposes of Anti-Money Laundering.
Some banking institutions may deduct charges for processing international payments. Please check with your bank if any
charges will apply prior to transferring your premium to us. If they do, please make sure that the amount your bank transfers
to us is enough, so that the remaining amount received by RL360 is at least equal to your premium.
This is to be used to conﬁrm which RL360 account your bank should pay monies to.
If you need help completing this form please contact our Customer Services Team on +44 (0)1624 681682 or alternatively you
can email email@example.com.
WHEN YOU HAVE COMPLETED THIS FORM
Please send the original signed instruction to your bank and a copy by post to: Payments Team, RL360, RL360 House,
Cooil Road, Douglas, Isle of Man, IM2 2SP, British Isles.
Or alternatively you can fax a copy to +44 (0)1624 677336.
by requesting a copy from our Data Protection Ocer.