Fillable Direct Deposit Authorization Form (Page 4 of 4) in pdf

Plumbers & Pipefitters National Pension Fund

UNDERSTANDING AND AGREEMENT For Direct Deposit

Your completion of the Direct Deposit Authorization form on the reverse side, with certification from your

bank, and your agreement below, and that of your Other Holders/Parties, if any, will allow the Plumbers

& Pipefitters National Pension Fund to deposit your benefit payment directly into your bank account

based on the following conditions and understandings.

Acknowledgment/Authorization of Payee/Account Holder/Payee

I understand and acknowledge that my pension payments may be sent only to my personal bank account,

and that such payments may not be made into a business account. I understand that payments to a trust

account must be reviewed and approved in advance, and the trustee(s) and I must sign additional forms. I

hereby authorize the financial institution named on the reverse side to return to the Fund any money

deposited into the account to which I am subsequently determined not to be entitled. I further authorize

the financial institution named on the reverse side to provide to the Fund Office the name(s) and

address(es) of those who may close this account before the Fund is able to recover any money deposited

into the account to which I am not entitled.

Acknowledgment/Agreement of Other Holders/Parties on the account

I/We, the other holders/parties, understand and acknowledge that I/we must immediately advise both the

Fund office and the financial institution of the death of the Payee/Account Holder. I/we understand,

acknowledge and agree that any money deposited into the account after the date of death of the

Payee/Account Holder is not an eligible payment and must immediately be returned to or recovered by the

Fund. I/We understand that the Fund will then make a determination regarding the survivor rights and

calculate the survivor benefit payment, if any, and forward the necessary papers to the Payee’s

Designated Beneficiary(ies) of record.

Cancellation of Direct Deposit

I/We, the undersigned, understand that this authorization and agreement remains in effect until cancelled

by the Payee/Account Holder. I/We understand that written notification to the Fund of cancellation of this

agreement/authorization must be made in such time and in such a manner as to allow the Fund a

reasonable opportunity to act on it. I/We understand that upon cancellation by the Payee/Account Holder,

the Payee/Account Holder must immediately notify the receiving financial institution that the Direct Deposit

Authorization has been cancelled.

Change of Address

I/We, the undersigned, understand and acknowledge that I/we must immediately inform the Fund of any

change in the mailing address of the Payee/Account Holder. I/We understand that the Fund office must be

able to send federal tax information to benefit recipients in January of each year. I/We understand that

there are other occasions when the Fund is required to inform the Payee/Account Holder of important

benefit information.

I/We understand that the Payee/Account Holder’s benefit could be stopped

temporarily if the Fund office cannot locate the Payee/Account Holder resulting from untimely notice of a

change of address.

I/We, the undersigned, certify that the information provided on this form is correct and

complete. I/We understand and acknowledge by my/our signature(s) below that I/we agree to

the obligations stated herein associated with the Direct Deposit Authorization granted by this

document.

Payee/Account Holder Signature ________________________________ Date _________________________

Other Holder/Party Signature __________________________________

Date _________________________

TTACH

DDITIONAL

IGNED COPIES AS

ECESSARY FOR ALL

OLDERS

ARTIES ON THE

CCOUNT

Direct Deposit Authorization Form Page 4

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