Pension Direct Deposit Bank Change Form printable pdf download

Pension Direct Deposit Bank Change Form

BANK CHANGE FORM

BMO Harris Bank, N.A.

as Custodian for the

Electrical Construction Industry Pension Plan

Authorization Agreement

For Direct Deposit of Pension Payments

Electrical Construction Industry Pension Plan

Retirement Plan Name

92-0008-03-4

Trust Account Number

I am payee in the above named plan and I hereby request that, until my written notice is

received by the BMO Harris Bank, N.A., all payments be directly deposited into my

account at the bank designated below.

Financial Institution: _______________________________________________________

Address: _________________________________________________________________

City & State: ______________________________________ Zip: ___________________

For Deposit To:

□ Checking

__ __ __ __ __ __ __ __ __

__________________________

Bank Routing Number

Account Number

(PLEASE ATTACH A VOIDED CHECK)

□ Savings

__ __ __ __ __ __ __ __ __

__________________________

Bank Routing Number

Account Number

(PLEASE ATTACH A DEPOSIT TICKET)

To correct any overpayments credited to my account during or after my lifetime, I hereby

authorize the bank designated to debit my account and to refund any such overpayment to

the BMO Harris Bank, N.A. as custodian for the Electrical Construction Industry Pension

Plan.

________________________________

______________________________________

Name (Please Print)

Social Security Number

________________________________

Signature

________________________________

Date

Pension Direct Deposit Bank Change Form