Stop Order Deduction

This signed Authority and Mandate refers to our contract dated ______________________ (“the Agreement”). I hereby authorise my employer to draw against my salary, the premium payable under the above plan on a monthly basis commencing on __________________(date) and pay it over to RMA Life Assurance Company Limited on my behalf. This request will remain in force, until cancelled by myself or my employer in writing. I understand that premiums are subject to change from time to time at the discretion of the underwriter and duly authorize the contractual premium deduction in accordance with the increases.