Get 25-0413.rev.bd

The 25-0413.rev.bd form is an electronic funds transfer authorization document that allows users to set up automatic withdrawals for their insurance premiums. This guide provides clear, step-by-step instructions to help you navigate and complete the form efficiently.

Follow the steps to successfully fill out the form.

1. Click 'Get Form' button to obtain the form and open it in your browser.
2. Fill in the policy number(s) in the designated area to identify your insurance policy.
3. Enter the insured's name clearly in the provided space, ensuring all details are accurate.
4. Complete the account holder’s name section by printing their name clearly.
5. Indicate the name of the financial institution where the account is held, along with the city and state.
6. Provide the full street address of the bank in the designated section.
7. Select the type of account by marking either 'Individual' or 'Business' and choose between 'Checking' or 'Savings.'
8. Input the bank routing number and bank account number accurately to ensure correct processing of withdrawals.
9. Choose a requested monthly draft date, selecting a date from the 1st to the 28th of the month that suits your needs.
10. Review the authorization statement and make sure you understand the agreement regarding the automatic withdrawals.
11. Sign the form in the designated area, ensuring your signature matches the one on your account.
12. Indicate your relationship to the insured or annuitant where required.
13. Complete the account holder's street address, city, state, and ZIP code if different from the one listed earlier.
14. Select 'Yes' or 'No' to indicate if the account holder's address is a new address.
15. Finally, review all information for accuracy, then save, download, print, or share the completed form as needed.

Complete your EFT authorization form online to ensure timely premium payments.