Managing finances, especially when it comes to ensuring timely payments of premiums for insurance policies, can often lead to unnecessary stress. Enter the BMO Authorization Form, a streamlined solution provided by the BMO Life Assurance Company. This form facilitates the automatic monthly withdrawal of premium payments directly from your bank account. Located at 60 Yonge Street in Toronto, this facility aims to simplify the payment process for policyholders. By completing this form, policyholders authorize BMO Life Assurance to debit their specified account not only for current dues but also for any outstanding premiums related to the policy number(s) mentioned. It states clearly that all deductions, deemed as Pre-Authorized Debits (PADs), will be considered personal transactions. Moreover, it highlights the ability of the payor to waive the right to a pre-notification of these debits, providing flexibility in managing finances. Furthermore, it underlines the payor’s rights to contest any debits that may not align with the agreement terms. Crucially, the form offers an exit strategy where policyholders can revoke their authorization, subject to a 30-day notice. It’s designed to instill a sense of control and transparency in financial dealings with the assurance of recourse in instances of dissatisfaction. Such features make the BMO Authorization Form an essential tool for policyholders seeking convenience and security in managing their premium payments.
| Question | Answer |
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| Form Name | BMO Authorization Form |
| Form Length | 1 pages |
| Fillable? | Yes |
| Fillable fields | 12 |
| Avg. time to fill out | 2 min 39 sec |
| Other names | bmo pre authorized payment form, bmo pre authorized debit, bank of montreal pre authorized debit form, bmo pad form online |
BMO Life Assurance Company
60 Yonge Street, Toronto, ON M5E 1H5
REQUEST FOR PRE
Automatic monthly withdrawals from your bank account
FOR POLICY NUMBER:
I/We authorize BMO Life Assurance Company to debit the account below to pay premiums, including overdue premiums, for the above numbered policy(ies) and any other policy(ies) I/We designate, on the _________ day of each month or the next business day.
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Attach a sample Cheque marked “VOID” |
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NAME OF |
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PAYOR: |
(please print) |
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NAME OF FINANCIAL INSTITUTION: |
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ADDRESS OF FINANCIAL |
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INSTITUTION: |
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BRANCH |
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ACCOUNT |
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NUMBER: |
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NUMBER: |
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Declaration:
I/We have chosen to make payments of premium using the
(ii)if I/We have not chosen an eligible deduction date, on the recurring premium due date specified in my/our policy.
I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/We have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD agreement. To obtain more information on my/our recourse rights, I/We may contact my/our financial institution or visit cdnpay.ca.
I/We may revoke my/our authorization at any time, upon providing 30 days notice, in writing, to BMO Life Assurance Company at the address shown above. I/We understand that I/We may obtain a sample cancellation form or further information on my/our right to cancel a PAD agreement at my/our financial institution, by contacting BMO Life Assurance Company or by visiting cdnpay.ca. If I/We require more information or have an issue regarding my/our PAD agreement with BMO Life Assurance Company, I/We understand that I/We may contact you at
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Signature of Payor(s) |
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® Registered