Third Party Payment Questionnaire - Hansard

Third Party Payment Questionnaire Page 2 of 16. Index Section Page number 1. Contract holder details 4. 2. Contract Details 4. 3. Source of Contribution Payments 4. 4. Source of Wealth 6. 5. Important Notes 12. 6. Data Protection 13. 7. Declaration 14. Page 3 of 16. Please note: Third Party payments may be acceptable in relationships between parent/guardian and child, husband and wife, employer and employee. Please also note that Hansard International Limited ( Hansard ) are unable to accept Third Party payments for contracts held in trusts. 1. Contract Holder Details Contract number Applicant 1. Applicant 2. 2. Contract Details Contribution amount Figures Currency Frequency of contribution Single Monthly Quarterly Half-yearly Yearly Payment method Standing Order/Telegraphic Transfer - If you would like Hansard to send the instruction to the bank, then Hansard requires the original. UK Direct Debit - Please note that Hansard must receive the original before the direct debit instruction is sent to the bank.

D D M M Y Y Y Y Please note: Third party payments may be acceptable in relationships between parent/guardian and child, husband and wife, employer and employee.

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