Employer's contribution authority form for Self ... - Legal & General

7DIRECT DEBITInstruction to your bank or building society to pay by Direct Debit.Please make sure that you fully complete all of the boxes and that this instruction is signed and dated.To Legal & General, Legal & General House,Kingswood, Tadworth, Surrey KT20 6EUService User Number8 0 6 1 6 27.1 Name and fullpostal addressof your bank orbuilding societybranchNameAddressPostcode7.2 Name(s) of account holder(s)7.3 Bank or building society account number7.4 Branch sort code7.5 Instruction to your bank or building societyPlease pay Legal & General Assurance Society Limited Direct Debits from the accountdetailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee.I understand that this Instruction may remain with Legal & General Assurance SocietyLimited and, if so, details will be passed electronically to my bank or building society.SignatureDateD D M M Y Y Y YCut off here and keep the Direct Debit Guarantee somewhere safe.The Direct Debit Guarantee – this Guarantee should be detached and retained by the payer.• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.• If there are any changes to the amount, date or frequency of your Direct Debit, Legal & GeneralAssurance Society Limited will notify you five working days in advance of your account being debitedor as otherwise agreed. If you request Legal & General Assurance Society Limited to collect a payment,confirmation of the amount and date will be given to you at the time of the request.• If an error is made in the payment of your Direct Debit, by Legal & General Assurance Society Limited oryour bank or building society, you are entitled to a full and immediate refund of the amount paid fromyour bank or building society.– If you receive a refund you are not entitled to, you must pay it back when Legal & General AssuranceSociety Limited asks you to.• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Writtenconfirmation may be required. Please also notify us.www.legalandgeneral.comLegal & General Assurance Society Limited. Registered in England and Wales No. 166055Legal & General Assurance Society Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authorityand the Prudential Regulation Authority.Legal & General (Portfolio Management Services) Limited. Registered in England and Wales No. 2457525Legal & General (Portfolio Management Services) is authorised and regulated by the Financial Conduct Authority.Registered office: One Coleman Street, London EC2R 5AAQ26344 08/13 NON ASD