Form 7075 (Rev. 2018-01) - Advice and Acknowledgement of ...



To:From: ATB FORMTEXT ????? FORMTEXT ?????(Head Office of Company) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Re Policy No. FORMTEXT ?????On Life of FORMTEXT ?????for $ FORMTEXT ?????We enclose in duplicate, assignment of the above-described policy in favor of ATB Financial, previously Alberta Treasury Branches (“ATB”). Please return one copy of the assignment with your acknowledgement on this form, showing thereon the following information pertaining to the policy. Your prompt attention is appreciated.(1) Name of Present Beneficiary: FORMTEXT ?????(2) The FORMCHECKBOX annualPremium due on FORMTEXT ????? FORMCHECKBOX has been paid in cash. FORMCHECKBOX half-yearly FORMCHECKBOX has been advanced under Automatic Premium Loan provision. FORMCHECKBOX quarterly FORMCHECKBOX is outstanding. FORMCHECKBOX monthly(3) Present Cash Surrender Value $ FORMTEXT ?????which includes Accumulated Dividends, if any, of$ FORMTEXT ?????.(4) Policy and Automatic Premium Loans, if any, total $ FORMTEXT ?????, which includes Accrued Interest of $ FORMTEXT ?????to FORMTEXT ?????.(Date)(5) Other Prior Registrations: FORMTEXT ????? FORMTEXT ?????(6) * Age of Assured has FORMCHECKBOX not been FORMCHECKBOX beenadmitted. FORMTEXT ?????(* If age not admitted, please indicate whether or not your company would require proof of age should policy become claim.)(7) Branch office of record: FORMTEXT ?????(8) Other pertinent information, if any, pertaining to this policy. FORMTEXT ?????We/I acknowledge the above information to be correct as at this date: FORMTEXT ????? FORMTEXT ?????(Date despatched)Please print name and positionSignature ................
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