Authorization Agreement for Storage of Credit Card Information

I hereby authorize the appropriate third party designee of the applicable company of the CHUBB Group—including without limitation, Bankers Standard Insurance Company, Pacific Employers Insurance Company, Atlantic Employers Insurance Company, CHUBB Insurance Company of the Midwest, CHUBB American Insurance Company, or Indemnity Insurance Company of North America (any CHUBB affiliate is hereafter the "Company" and collectively, the "Companies")—to initiate on behalf of such Company the credit card transaction(s) for the payment of my premium and, if I select recurring payment option, for future premium payments on a recurring basis on the credit card provided. I hereby represent and warrant that I am legally authorized to initiate and/or make all such credit card transactions. I further agree to make all present and future payments under the recurring charge authorization according to my credit card statements. I understand my insurance may be cancelled if my credit card is declined or if I contest any recurring charge made under this authorization. All recurring charges will show on your credit card statement under one of the CHUBB Companies. I understand that if there are any changes to my credit card account, including without limitation an updated credit card number and/or expiration date, I must sign in to my account at www.chubb.com to update the enrollment information in order to ensure the payment will process successfully. In addition, I understand that the Company may terminate this agreement upon prior written notice to me, which may be delivered by e-mail or other electronic means. I understand that my authorization for using and storing my payment card and other related information, and/or initiating charges against my payment card accounts, will remain in full force and effect until I provide notice to Company of termination of my authorization, which can be provided by me by signing into my account at www.chubb.com and unenrolling from AutoPay. I further represent and warrant that all my payment card transactions and corresponding acts or omissions will at all times comply with applicable laws in the United States of America.