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 Direct Deposit Enrolment or Changes Disability Claims 02728 2017

Direct Deposit Enrolment or Changes Disability Claims 02728 2017

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Account in accordance with this authorization will be identified with a DIRECT DEPOSIT transaction code and I acknowledge that the credit in question shall constitute an amount paid in accordance with this authorization. This authorization will be effective on terminate following a 10-day written notice by either Desjardins Insurance or me. City Telephone no. Province Postal code - I hereby authorize Desjardins Financial Security Life Assurance Company hereinafter Desjardins Insurance to...
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