I authorize Empire Life to charge the Initial Premium Payment to the credit card account indicated. I confirm that I am the proposed owner of the policy and the credit card being used for payment is owned by me. I understand that making this payment does not mean that a policy will be issued. A policy will only be issued if I sign this application, Empire Life receives this application electronically, my payment is honoured and I am approved for insurance (other than temporary insurance).
Note: the cardholder must be the proposed owner of the policy.
Please note: subsequent premium payments must be made via pre-authorized debit from your bank account. Your banking details will be collected at signature.
Our refund policy:
Should you decide to cancel your policy, a full refund of the initial premium payment will be credited to you if we receive your written cancellation notice within 10 calendar days of you receiving your policy.