Imrf Form 1199 - Application For Direct Deposit
Download a blank fillable Imrf Form 1199 - Application For Direct Deposit in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Imrf Form 1199 - Application For Direct Deposit with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Application for Direct Deposit
IMRF Form 1199 (Rev. 07/07)
This form should be completed by the Benefit Recipient (IMRF member or person
receiving the IMRF benefit payment).
Name
IMRF Member ID
Address (Number, Street)
City
State
Zip
Is this a new address?
Telephone Number
(
)
Yes
No
Account
Information—Important: The name of the person who will receive the IMRF
benefit payments must be on this account.
Please provide the information requested
below. If you are unsure of any of the requested information, contact the financial
institution where you have your account. (See the back of this form for more information.)
Name of Financial Institution
Branch Telephone Number
(
)
Branch Address (Number, Street)
City
State
Zip
Account Number
Financial Institution Routing Number
Type of Account
Checking
Savings
I authorize and request the Illinois Municipal Retirement Fund to direct IMRF recurring payments for crediting to my account
at the financial organization designated above. This authorization is not an assignment of my right to receive payment and
revokes all prior payment direction notifications applicable to these payments. I understand that the financial organization
designated reserves the right to cancel this agreement by notice to me; however, this authorization will remain in effect with
IMRF will stop direct deposit
IMRF until cancelled by notice from me or by my death. Further, I understand and agree that
if I fail to keep IMRF informed of my current
address. I also permit the release by the bank or financial institution of my
current address to IMRF. I understand that a new Form 1199 is required if I change my financial institution, my account
number
or
my name.
X___________________________________
________________
Signature of Benefit Recipient, Power of Attorney*, or Guardian*
Date
*Attach court documents if not already submitted
Fax your completed form to IMRF at 630-368-5398 or mail it to:
IMRF, 2211 York Road Suite 500, Oak Brook IL 60523-2337
Member Service Representatives 1-800-ASK-IMRF (1-800-275-4673)
IMRF Form 1199 (Rev. 07/07)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business