AUTHORITY TO A BANK TO PAY PREMIUMS FOR LIFE INSURANCE POLICY
 
…………………………

…………………………
Date: .......................
 
To
 
The Manager,
.........................Bank
	.......................Branch
…………………………

Dear Sir,
 
	I hereby request you to pay from my Savings Bank Account No …………………………maintained with you, the premiums on the policy of Insurance No……………for Rs . ……………………with the Life Insurance Corporation of India ……………………Branch.

(i) Branch to which premium is to be paid:
	(ii) Amount of premium:
(iii) Date of payment of premium:

Yours faithfully,