WHO IS THIS FORM FOR?
This form is for holders of Protected Lifestyle Lebanon policies who wish to send a premium payment to us by telegraphic transfer.
COMPLETING THIS FORM
Please 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.
If you need help completing this form please contact our Lebanon Oce on +961 (1) 202 183/4 or alternatively you can email
WHEN YOU HAVE COMPLETED THIS FORM
Please send the original signed instruction to your bank and a copy by post to: RL360, Burj Al Ghazal, 8th Floor, Fouad Chehab
Highway, Ashraﬁeh, Tabaris, Lebanon.
Or alternatively you can fax a copy to us on +961 (1) 202 159.
Data Protection Ocer.
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.