Get Premium Payment Authorization Form

Filling out the Premium Payment Authorization Form online is a straightforward process that allows you to authorize automatic payments for your insurance premiums. This guide offers a step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to access the Premium Payment Authorization Form and open it for editing.
2. Begin by entering the insurance company name and postal address in the designated section. This information ensures your payments are directed to the correct insurer.
3. Indicate if this is a new request or a change of existing information. Fill in your policy number to link your payment authorization to your policy.
4. Provide your full name and postal address in the applicant's section. Make sure to fill all required fields clearly.
5. In the brokerage/agency information section, include the contact name, numbers, and preferred document language. Choose either English or French as preferred for communication.
6. For policy premium data, fill in the total estimated policy premium, any applicable provincial sales tax, installment fee, and total estimated cost.
7. Read the consent and disclosure section carefully, ensuring you understand the terms regarding automatic withdrawals. Provide your signature to confirm acceptance.
8. Select your method of payment. Choose either a single payment or a payment plan, and specify the type of plan if applicable.
9. If using a credit card, fill in the credit card information, including card number, expiration date, and cardholder’s signature. For bank account payments, provide all necessary bank details and attach a void cheque.
10. Sign and date the form where indicated. Ensure that all signatures match those authorized for the account provided.
11. Once completed, verify that all information is accurate. You can then save changes, download, print, or share the form as needed.

Complete your Premium Payment Authorization Form online today for a seamless payment experience.