CC 100x500 Pads 12/21 | E ERNAKULAM DIVISION ees or Pet Letter of Authorisation to the Employer to deduct Premium in respect of policies taken out under the Salary Deduction Scheme / Salary Saving Scheme. FOR THE ATTENTION OF PROPOSER/ (NAME AND ADDRESS OF THE EMPLOYER) POLICY HOLDER Kindly ensure deduction of premium from salary to avoid lapsation of policy Dear Sirs, Re : Policy No. ... . own life Salary Deduction Scheme / Salary Savings Scheme have taken out a Life Insurance Policy with the Life insurance Corporation of india and | desire to pay premium by deduction from salary every month. | request you to kindly arrange to deduct and pay to the Life Insurance Corporation of India, Divisional / Branch Office svnanuthe@ premium amount stated below from my salary commencing from this month and: to deduct and pay such amounts every month til further advice | agree that your liability will be confined to making arrangements for deduction of premium from my salary wherever this can be made and remitting the amount to the Corporation in time. | shall be entirely responsible for any consequence on account of non-payment of premium on my policy for reasons beyond your control, such as in the event of my proceedings on leave without pay or my drawing advance salary without or deduction of premium or my cancelling this authorisation for deduction of premium or my leaving your employment. In any such case or in case of withdrawal of the Salary Savings Scheme with you by the Life Insurance Corporation of India for any reason whatsoever, it will be my responsibility to make arrangements for remittance of the premiums directly to the Corporation at the increased rate specified in the policy to prevent my policy from going into a lapsed condition. Yours faithfully, (Signature) (In Block Letters) SS. COD ornresnrnnnnnn Department in which working .. Salary Roll or Badge No. where necessary. Tobe filled in byL..c. Paying Authority Code No. Date of Commencement... Plan &Term Deduction to Commence from the salary forthe month of. ‘Agency Code No.