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Please fill in the whole form, including official use box, using a ball point pen and send it to: Pantaenius UK Limited Marine Building 1 Queen Anne Place Plymouth Devon PL4 0FB Instruction to your bank or building society to pay by Direct Debit Service User Number 8 0 9 4 2 8 Name(s) of Account Holder(s) FOR PANTAENIUS UK LTD USE ONLY This is not part of the instruction to your bank or building society Frequency of Payments (N.B. Legal Expenses and Yacht Insurance without a Hull policy, cannot be paid by instalments.) Bank/Building Society account number Monthly Six Monthly Branch Sort Code Name and full postal address of your Bank or Building Society To: The Manager Bank/Building Society Address Quarterly Annually Instruction to your Bank or Building Society Please pay Pantaenius UK Ltd Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Pantaenius UK Ltd and if so, details will be passed electronically to my bank/building society. Signature(s) Post Code Reference Date Banks and Building Societies may not accept Direct Debit Instructions from some types of account. This guarantee should be detached and retained by the Payer. The Direct Debit Guarantee • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. • If there are any changes to the amount, date or frequency of your Direct Debit, Pantaenius UK Ltd will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Pantaenius UK Ltd to collect a payment, confirmation of the amount and date will be given to you at the time of the request. • If an error is made in the payment of your Direct Debit by Pantaenius UK Ltd or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. - If you receive a refund you are not entitled to, you must pay it back when Pantaenius UK Ltd asks you to. • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us. WAYS TO PAY YOUR PREMIUMS Annually By Cheque, payable to Pantaenius UK Limited and sent to Pantaenius UK Limited, Marine Building, 1 Queen AnnePlace, Plymouth PL4 0FB. Please add £10 (or the equivalent) to cheques drawn on non-UK Banks or not drawn in Sterling. By Bank Transfer to Pantaenius UK Ltd-Insurance Premium Account with NatWest Bank Plymouth Branch, 14 Old Town Street, Plymouth, UK PL1 1DG: Sterling & US Dollar Payments Sort Code: 56-00-63 SWIFT: NWBKGB2L Account No.: 3706 7796 IBAN: GB27 NWBK 5600 6337 0677 96 SWIFT: NWBKGB2L IBAN: GB54 NWBK 6072 1239 0929 76 Euro Payments For Bank Transfers, please use your Customer Number as a reference. Please ensure payments from non-UK Banks include £5.00 towards bank charges. By Direct Debit (only available for policies in GBP and from a UK bank account). Complete and return the Direct Debit Form overleaf before the Due Date shown on the Invoice or within seven days of receipt of the premium invoice and we will set up a Direct Debit. Payments will be debited on the 15th of the month and we will give you 10 days’ notice before taking the first payment. If a Direct Debit instruction is cancelled by you before the end of the Insurance Period, or if any direct debits are rejected by your bank, all the remaining premiums for the insurance year will immediately become payable in full. By Credit or Debit Card – Please call us with your credit/debit card information. Instalments If you would like to take advantage of our FREE instalment option, you will be required to set up a facility to allow automatic payment collection. Please note that Legal Expenses, Crew Medical Insurance, Employer's Liability Insurance, Protection & Indemnity Insurance, Travel Insurance, and Yacht Insurances that do not include a Hull policy cannot be paid for in instalments. By Direct Debit (only available for policies in GBP and from a UK bank account). Complete and return the Direct Debit Form overleaf before the Due Date shown on the Invoice or within seven days of receipt of the premium invoice and we will set up a Direct Debit. Payments will be debited on the 15th of the month and we will give you 10 days’ notice before taking the first payment. If a Direct Debit instruction is cancelled by you before the end of the Insurance Period, or if any direct debits are rejected by your bank, all the remaining premiums for the insurance year will immediately become payable in full. By Credit or Debit Card If you choose to pay using a Credit/Debit card by instalments, you will be required to provide authorisation for automatic payment collection. To change to this payment method, please call us. + 44 (0)1752 22 36 56 WAYS TO PAY FOR YOUR INSURANCE Pantaenius UK Limited • Marine Building • 1 Queen Anne Place • Plymouth • PL4 0FB Tel: +44(0) 1752 22 36 56 Fax: +44(0) 1752 22 36 37 www.pantaenius.co.uk Email: [email protected]