Fillable STANDING ORDER INSTRUCTION SERVICING WHO IS THIS FORM (RL360)

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STANDING ORDER INSTRUCTION SERVICING WHO IS THIS FORM (RL360)

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1
WHO IS THIS FORM FOR?
This form is for plan owners who
wish to send a payment to us by
standing order. Depending on
the type of contract you hold,
this payment option may not be
available for specific payment
frequencies, please check your
plan literature or contact us
before completing.
You should use this form
if you hold:
• an RL360 contract
• an old Scottish Life
International policy
• an old Scottish Provident
International policy except
th
ose taken out whilst resident
in Hong Kong
• a Protected Lifestyle
Lebanon plan
Fo
r old Scottish Provident
International policies taken out
whilst resident in Hong Kong
please use the Standing order
instruction – Hong Kong (reference
number – RL183).
COMPLETING THIS FORM
The form is split into 2 sections.
Section 1
This is where you instruct your
bank that you would like to debit
an amount of money from your
account in relation to your plan.
You must complete this section
in full, making sure that all plan
owners, trustees or authorised
signatories sign.
Where applicable, please ensure
that the authorised signatory list(s)
that we hold for your contract
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.
Section 2
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 csc@rl360.com.
WHEN YOU HAVE COMPLETED
THIS FORM
Please send the original
signed instruction to your
bank and a copy by email
to premiums@rl360.com or
alternatively you can post it
to Premiums Team, RL360,
International House, Cooil Road,
Douglas, Isle of Man, IM2 2SP,
British Isles
Or alternatively you can fax a copy
to +44 (0)1624 677336.
IMPORTANT
If you wish to change the
amount you pay into your plan,
including as a result of automatic
premium escalation, you will
need to complete a new standing
order instruction. If you wish
to cancel your standing order
you will need to do this directly
through your bank.
STANDING ORDER
INSTRUCTION
SERVICING
2
SECTION 1
You must complete this section in full, making sure that all plan owners, trustees or authorised signatories sign.
To the manager
Bank/Building Society
Bank address
Plan number
(please use this number as the reference for payments)
Plan owner name(s)
Please debit the payment amount, together with any transfer charges, from my account detailed below:
Plan currency Sterling (GBP) US dollar (USD) Euro (EUR) Swiss franc (CHF)
Australian dollar (AUD) Hong Kong dollar (HKD) Japanes Yen (JPY)
(For a Protected Lifestyle Lebanon plan, only USD can be selected)
Payment amount in figures
Payment amount in words
Payment frequency Monthly
Quarterly
Half-yearly
Yearly
(For a Protected Lifestyle Lebanon plan, only half-yearly or yearly can be selected)
Payment start date
(dd/mm/yyyy)
Name(s) of account holder(s)
Branch SWIFT code
OR Bank sort code
- -
(for all non–GBP and international payments) (for UK GBP payments only)
SWIFT code must be either 8 or 11 digits
IBAN/account number
OR
Account number
(all non–GBP accounts) (GBP UK Bank only)
Plan Owner/Trustee/Authorised Signatory 1
Plan Owner/Trustee/Authorised Signatory 2
Signed
Full name
Current residential address
and postcode (in full)
Date (dd/mm/yyyy)
Plan Owner/Trustee/Authorised Signatory 3
Plan Owner/Trustee/Authorised Signatory 4
Signed
Full name
Current residential address
and postcode (in full)
Date (dd/mm/yyyy)
3
SECTION 2
Please select the correct account from the options below. If you have any diculties, please contact us first.
Option 1
Choose from these accounts if you have an RL360 (except Protected Lifestyle), old Scottish Provident International or old
Scottish Life International Paragon contract.
Tick one Currency SWIFT code IBAN Sort code Account
number
Bank name Account
name
AUD CITIGB2L GB45 CITI 1850 0813 1419 34 18-50-08 13141934 Citibank, London RL360
CHF CITIGB2L GB26 CITI 1850 0813 1418 88 18-50-08 13141888 Citibank, London RL360
EUR CITIGB2L GB20 CITI 1850 0813 1418 02 18-50-08 13141802 Citibank, London RL360
GBP CITIGB2L GB34 CITI 1850 0813 1420 35 18-50-08 13142035 Citibank, London RL360
HKD CITIGB2L GB10 CITI 1850 0813 1416 91 18-50-08 13141691 Citibank, London RL360
JPY CITIGB2L GB26 CITI 1850 0813 1415 00 18-50-08 13141500 Citibank, London RL360
USD CITIGB2L GB54 CITI 1850 0813 1415 78 18-50-08 13141578 Citibank, London RL360
Bank address
Citibank, Citigroup Centre, Canada Square, Canary Wharf, London, E14 5LB, UK.
Option 2
Choose from these accounts if you have a RL360 Protected Lifestyle or old Scottish Life International contract (except Protected
Lifestyle Lebanon or Paragon).
Tick one Currency SWIFT code IBAN Sort code Account
number
Bank name Account
name
EUR CITIGB2L GB04 CITI 1850 0813 1417 99 18-50-08 13141799 Citibank, London RL360
GBP CITIGB2L GB87 CITI 1850 0813 1420 51 18-50-08 13142051 Citibank, London RL360
USD CITIGB2L GB32 CITI 1850 0813 1415 86 18-50-08 13141586 Citibank, London RL360
Bank address
Citibank, Citigroup Centre, Canada Square, Canary Wharf, London, E14 5LB, UK.
Option 3
This is for owners of a Protected Lifestyle Lebanon plan that wish to make their payment locally.
Tick Currency SWIFT code IBAN Account number Bank name Account
name
USD BLOM LBBX LB81 0014 0002 1002 3042 4002 1659 1002304240021659 BLOM Bank RL360
Bank address
The bank address for the above account is: Blom Bank S.A.L, Blom Building, Rashid Karameh Street, 1107 2807, Lebanon.
RL175d 01/20
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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Completed 21 June 2021

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