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Bank Draft Authorization Form

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Presentation notes to be used as a guide when filling out a bank draft authorization form

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Bank Draft Authorization



Bank Name: CIBC

Address For the Bank: Unit # 1 – 11825 Bramalea Road, Brampton (ON),
Canada

Transit/Aba Number: 03462

Account Number: 5461292

Type Of Account: Chequing

Signature of the payor:

Date: Today’s date

Name of the Insured: Xyz

Policy Number of existing policies: 1016938141 (10 year renewable term
life),169365 (Group Optional Life Insurance policy to cover expenses like
funeral costs, debt payments, mortgage payments, family living expenses,
childcare and aging parents), 20512 (Policy Number)

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