Pbgc Form 705 - Beneficiary Application For Pension Benefits - 2006 Page 4
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4Form 705, page 4 of 4
Beneficiary Application for Pension Benefits
Plan Number:
Participant Name / SSN:
Applicant Name / SSN:
4. Method of receiving benefit payments
How would you like to receive your payments?
MARK ONLY ONE
A. By Electronic Direct Deposit (EDD),
to the account identified below, which must have your
name on it.
B. By mail to my home address,
which is printed in section 1 of this form. You may choose this
option if you cannot use EDD because of physical, mental, geographic, language, or literacy
barriers; or if using EDD would cause you financial difficulties.
5. Financial institution information
–
Please provide the information in this section to have your payment sent
directly to a financial institution. The financial institution will receive and post credits and/or debits for you. You may
cancel or change this arrangement by calling PBGC at 1-800-400-PBGC. The financial institution can cancel it by sending
you a written notice.
The information below is available from your financial institution, or you may find it on your checks, account statement, or
deposit slip. There are three numbers printed on the bottom of your check: the financial institution’s routing number, your
account number, and your check number. The routing number must be nine digits. The first two digits must be 01 through
12 or 21 through 32. Your account number can be up to 17 characters (both numbers and letters). Include hyphens but
omit spaces and special symbols. Be sure not to use the check number. If you are unsure of the routing number or your
account number, contact your financial institution.
Name of Financial Institution
Branch
Mailing Address
City
State
Zip Code
Name of Contact Person
Routing Number
Financial Institution Phone Number
Extension
(
)
-
x
Name(s) on the Account
Account Type
Checking
Savings
Account Number
PLEASE REVIEW THIS FORM FOR REQUIRED SIGNATURES BEFORE YOU SUBMIT IT.
A MISSING SIGNATURE COULD DELAY YOUR FIRST PAYMENT.
THANK YOU
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