Fillable TELEGRAPHIC TRANSFER INSTRUCTION HONG KONG SERVICING WHO IS (RL360)

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TELEGRAPHIC TRANSFER INSTRUCTION HONG KONG SERVICING WHO IS (RL360)

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Country of origin: UK
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1
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 taken out whilst resident in Hong Kong
• an old Scottish Provident International policy taken out whilst resident in Hong Kong
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
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.
Important
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.
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 Hong Kong Oce on +852 3929 4333 or alternatively you can email
hongkong@rl360.com
.
WHEN YOU HAVE COMPLETED THIS FORM
Please send the original signed instruction to your bank and a copy by post to: RL360, Unit 803, One Kowloon, 1 Wang Yuen
Street, Kowloon Bay, Kowloon, Hong Kong.
Or alternatively you can fax a copy to us on +852 2169 0181.
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.
TELEGRAPHIC TRANSFER
INSTRUCTION
HONG KONG
SERVICING
2
Section 1
You must complete this section in full, making sure that all policyholders, trustees or authorised signatories sign.
To the manager
Bank/Building Society
Bank address
Policy number
(please use this number as the reference for payments)
Policyholder name(s)
Please debit the payment amount, plus any transfer charges from my account below:
Currency (please tick
appropriate box)
Payment amount in figures
Payment amount in words
Payment commencement
until further notice.
date (dd/mm/yyyy)
Name(s) of account
holder(s)
Branch Swift Code
(for all non–GBP and International payments)
Swift Code must be either 8 or 11 digits
IBAN
(all non–GBP accounts)
Policyholder/Trustee/Authorised Signatory 1
Policyholder/Trustee/Authorised Signatory 2
Signed
Full name
Current residential address
and postcode (in full)
Date (dd/mm/yyyy)
Trustee/Authorised Signatory 3 Trustee/Authorised Signatory 4
Signed
Full name
Current residential address
and postcode (in full)
Date (dd/mm/yyyy)
Sterling (GBP)
US dollar (USD) Euro (EUR)
Hong Kong dollar (HKD)
3
Section 2
Please select the correct account from the options below. If you have any diculties, please contact us first.
Tick one Currency IBAN number Account number Swift code Bank name Account name
EUR 500 211 461 220 HSBCHKHH HSBC RL360
GBP 500 211 461 202 HSBCHKHH HSBC RL360
HKD 500 211 461 001 HSBCHKHH HSBC RL360
USD 500 211 461 201 HSBCHKHH HSBC RL360
Bank address
HSBC, 1 Queen’s Road Central, Hong Kong.
RL179e 01/21
Registered Oce: International House, Cooil Road, Douglas, Isle of Man, IM2 2SP, British Isles. The
appointed representative in Hong Kong is RL360 Insurance Company Limited’s Branch oce:
RL360 Insurance Company Limited, Unit 803, One Kowloon, 1 Wang Yuen Street, Kowloon Bay,
Hong Kong. Registered in the Isle of Man number 053002C and in Hong Kong Number F9136.
RL360 Insurance Company Limited is authorised by the Isle of Man Financial Services Authority.
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TELEGRAPHIC TRANSFER INSTRUCTION HONG KONG SERVICING WHO IS (RL360)

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Completed 21 June 2021

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