Common use of Notice to Applicant Clause in Contracts

Notice to Applicant. You should retain a copy of this Agreement. The Original will be retained by Protective Life Insurance Company. Date: Agent Signature: Date: Owner Signature: ALL MONIES WILL BE DRAFTED/DEPOSITED IMMEDIATELY UPON RECEIPT OF THIS FORM.

Notice to Applicant. You should retain a copy of this Agreement. The Original will be retained by Protective Life Insurance Company. By my signature I am attesting that I understand the terms and conditions of the Conditional Receipt Agreement. I am also authorizing the Company to withdraw the amount of $ from my account to pay the initial premium for the application on (Name of Proposed Insured) . Date: Agent Signature: Date: Owner Signature: ALL MONIES WILL BE DRAFTED/DEPOSITED IMMEDIATELY UPON RECEIPT OF THIS FORM.