Third Party Payment Authorization Form

This form is for third parties (defined as the spouse of the LAWYER, or the spouse of another LAWYER; a non-lawyer employee of the LAW FIRM, other than a PARALEGAL PARTNER OR SHAREHOLDER; or any other third party) who would like to make a payment, via credit card or pre-authorized debit, on behalf of a LAWYER. If you are a LAWYER and would like to submit a payment authorization for your premium or the premium of another LAWYER, please sign-in to your own My LAWPRO account.

Please note that if changes are to be made to the payment information or instalment payment option currently on file, LAWPRO must be advised in writing of such changes at least ten (10) days prior to any payment date. If written notice is not received at least ten (10) days prior, premium payments will be processed using the payment information currently on file.

1. Name(s) and Law Society of Ontario number(s) of LAWYER(S) to whom this payment authorization applies:

Last Name First Name Law Society of Ontario number

2. Payor's Information
First and Last Name:
Telephone Number:
Email Address:

3. Type of Premium
("PL") Professional liability insurance premiums payable by LAWYER(S) under the LAWPRO primary program, including: the base premium, any Innocent Party Insurance Coverage premium (including mandatory and Optional Innocent Party Sublimit Buy-Up), Real Estate Practice Coverage Option premium, and/or Claims History Levy Surcharge premium; but excluding any transaction levy surcharges, Excess Insurance Coverage premium, and increased Run-Off Coverage premium.

("EL") Excess Liability Insurance premium payable for this optional insurance coverage for the insured.

("IROP") Increased Run-Off Protection insurance premium payment for this optional insurance coverage for the LAWYER.

 

4. Method of Payment
Please choose one of the following payment methods:
Payment by credit card
Payment by pre-authorized debit
 

5. Payment Plan(s)
Chose one payment plan for each type of premium payment chosen above.

 PL  EL  IROP  
Lump sum (payable today)
  Quarterly (payable on the 15th day of every January, April, July, October)
  Monthly (payable on the 15th day of every month, beginning next month)
    Annual (The first instalment is payable on the inception date. Subsequent payments are payable annually on the 15th day of the inception month. These payments will be made over the full term of the policy)

6. Special Instructions

7. Premium Payment Authorization

In accordance with the chosen payment method and payment plan, the payor authorizes Lawyers' Professional Indemnity Company (LAWPRO) to charge the designated credit card or withdraw from the designated account and financial institution, the selected insurance premium including applicable taxes, for the specified LAWYER(S). LAWPRO does not charge for this service (but the designated credit card company or financial institution may). The payor has read, understands and accepts the foregoing and the following terms and conditions:

  1. The payor hereby certifies that the information provided in this Authorization Form is correct and that the payor will notify LAWPRO in advance in writing (and no less than ten [10] days prior to any payment date) in the event of any changes.
  2. The payor hereby acknowledges that, this authorization form shall form part of the LAWPRO insurance application(s) and the POLICY/POLICIES of the LAWYER(S) and, shall continue to be used for any and all future renewal or replacement policies for the coverage(s) indicated in Section 3 without further authorization by the payor so long as the payor so elects.
  3. The payor hereby certifies that the designated credit card, or designated financial institution account if paying by PAD, is in good standing, with sufficient funds to cover the above-noted premium payments as they become due and that all person(s) required to sign this Authorization Form has/have signed.
  4. All payments will be drawn on a Canadian credit card or financial institution and will be withdrawn in Canadian funds.
  5. The payor consents to LAWPRO's use and disclosure of his/her personal information referenced in this Authorization to the financial institutions involved in the payment process.

Please check this box to evidence your signature for the Declaration above.

Next steps (Note that you must first 'Review' your Third Party Payment Authorization form before being able to submit it online):

  • Click 'Review' to see a summary of the information you entered; OR
  • Click 'Cancel' to exit the form.

For more information about this form, please contact LAWPRO Customer Service at: 1-800-410-1013, or (416) 598-5899 in Toronto or via e-mail at [email protected].