S.L. 403.10 Art. 5nothing with the to have repaid to connection with form attached to whose particulars 7. If you acknowledge its copy of this Signed Name in block Office MAKE SURE RETURN A WHO HAS RECEIPT I, the Notice relating a copy. Signed Name in block Date NOTICE is sent) be identified,

If you wish to go ahead with the transaction you should do attached notice of cancellation. But if you wish to withdraw and you any money you have paid to the insurer or his representative in the contract, you should serve notice of cancellation (either on the this notice or otherwise in writing to the same effect) to the insurer are given in paragraph 1 of this notice within the period of 30 days. Acknowledgement have been served with this notice by hand, you are asked to receipt by signing the sub-joined form hereunder on a duplicate notice. ...................................................

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THAT YOU KEEP THIS NOTICE AND THAT YOU ONLY COPY THEREOF, DULY SIGNED AND DATED, TO THE PERSON SERVED IT ON YOU.

undersigned, hereby declare that I have been served with the Statutory to the long term business contact of insurance, of which the above is

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LINKED LONG TERM CONTRACTS OF INSURANCE - STATUTORY To: ....................................................................................................................... (Insert name and address of the person to whom this Notice IMPORTANT - READ THIS NOTICE CAREFULLY YOUR RIGHT TO CHANGE YOUR MIND

.............................................................................................................................. (Identify the contract to which the notice relates or state how it may e.g. by reference to an accompanying contract note)