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I/We may obtain a sample cancellation form or further information on my/our right to cancel a payment authorization agreement at my/our financial institution or by visiting www. A second presentation or attempt to withdraw funds 2. A second withdrawal notice 3. Cancellation of the policy Continued on Page 2 CSIO S0910ENGP - Payment Authorization Form - 2010/06 Page 1 of 2 2010 Centre for Study of Insurance Operations. 12 The account that my/our f.

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