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Standing Order (PREMIUM INCREASE) Form

    STANDING ORDER

    (PREMIUM INCREASE)



    Percentage increase:

    5%10%15%20%15%

    To Whom Payable: Nico Life Insurance Company Limited


    This is a replacement of the existing deduction.


    This instruction is given on the strict understanding that neither I nor my heirs nor assigns shall have any claim against my employers for damages in the event of the payments herein stipulated not being made by the due date for the reason whatsoever, including negligence. It being further understood that the employer undertakes this service solely on a non- commital and non-liability basis.

    To:

    Wisechoice Insurance Agency