| Please provide full details of the bank or building society account you would like your commissions paid to. | |
| Name of Bank/ Building Society | Barclays Bank |
| Address line 1 | Town Hall |
| Address line 2 | Town Hall Sq |
| Address line 3 | Grimsby |
| Postcode | DN31 1HX |
| Name(s) account held in
(If you are an AR Ltd Company or LLP firm, this account must be in the firm name) | Mr Thomas A Dent |
| Sort Code | 203527 |
| Account Number | 93086720 |
| How long have you held an account with this bank? | 11 Years |
| How would you like your life commissions paid (select one option)
- Indemnity – commission is paid to you as one lump sum payment and subject to a clawback liability.
- Non-Indemnity – commission is paid on a monthly split over the period of the policy, with no claw-back liability.
If you decide to select Indemnity, you will have the choice to select non-indemnity per policy if preferable. | Indemnity (upfront commission with clawback liability) |