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:
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 Hong Kong Oce on +852 3929 4333 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, 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.