Common Contracts
1 similar Pre-Authorized Withdrawal Agreement contracts
PROTECTIVE LIFE AND ANNUITY INSURANCE COMPANYPre-Authorized Withdrawal Agreement • February 8th, 2022
PRE-AUTHORIZED WITHDRAWAL AGREEMENT FOR DRAFTING OF PREMIUM PAYMENTS The person paying the premium on the life insurance policy listed below must sign this agreement. I request and authorize Protective Life and Annuity Insurance Company to draw against the account listed below to pay premiums once a policy has been issued. I understand that no coverage exists until a policy is issued or I receive a Conditional Receipt. Policy Number: Name of Insured: Name of Bank: Street Address or P.O. Box: City: State: Zip Code: Type of Account: Checking Savings Routing Number: Account Number: Premium Frequency: *Monthly (*Only available by bank draft) Quarterly Semi-Annually Annually Draft the initial premium - I understand that authorizing the drafting of the initial premium and providing the account information does not provide any life insurance coverage on myself or any applicant listed on the application for life insurance unless I have signed, dated and met the term
