Electronic Funds Transfer (EFT) Authorization (ACCOUNT CHANGE)

Authorization statement:
By signing this Electronic Funds Transfer (EFT) Authorization form, you are agreeing to the following:
• I authorize the Luso-American Financial and my banking institution listed above to have my account debited for premium
payments on my policy.
• In the unlikely event that funds to which I am not entitled to are deposited into my account, I authorize Luso-American
Financial to direct the bank to return said funds Luso-American Financial.
• I understand that my transaction may not be credited to my account until midnight on the date of the transaction or
following business day.