If depositing into a savings account, please complete the required information, sign the authorization and provide a copy of your banking statement. If depositing to a chequing account, please sign the authorization, and attach a copy of a void cheque in the area below.

I hereby authorize Manulife to deposit, until further notice, payment due to me from the above policy, into my bank account. I agree that Manulife will have no further liability with respect to any payments made in accordance with this authorization, and may at any time discontinue payment as requested herein and require my personal endorsement. I, for myself, my heirs, my executors, administrators, and assigns do hereby consent and agree that any sums of money so paid to the bank after my death shall be refunded to Manulife for distribution the person or persons, if any, entitled thereto under the terms of the policy. For Group Life and Health policies, I authorize the use of my Social Insurance Number (SIN) when applicable for the purposes of my request for Direct Bank Deposit. I authorize the use of my SIN for the purposes of identifi cation and administration, if my SIN is used as my certifi cate number. The above request and authorization apply to any other account in this financial institution or any other financial institution subsequently named by me.