Form Rsa Ddr - Rsa Direct Deposit Authorization

RSA Direct Deposit Authorization

Retirement Systems of Alabama

PO Box 302150, Montgomery, Alabama 36130-2150

877.517.0020 • 334.517.7000 •

Name ________________________________________________ SSN

Financial

Depositor Account No ______________________________________________ Bank Routing No ____________________

Institution

Information

Financial Institution Name __________________ _________________________ Type of Account q Checking q Savings

To be

completed by a

Mailing Address ___________________________________________________________________________________

representative

Street or P.O. Box

City

State

ZIP Code

of the financial

Name(s) of Person(s) on this Account

institution

Financial

Institution

MASTER AGREEMENT

Certification

In accordance with the provisions of Section 3.6.4 of the 2012 National Automated Clearing House Association (NACHA) Operating

Rules and Guidelines, both the Retirement Systems of Alabama (RSA), as the Originator, and the above named Financial Institution

consider the following to be the Master Agreement, as defined by the NACHA Operating Rules and Guidelines, and agree that it is to be

applicable to all payments sent by the RSA to the Financial Institution for the benefit of all benefit recipients having accounts with the

Financial Institution.

In consideration of the RSA making benefit payments in accordance with this Direct Deposit Authorization without requiring proof that

the retiree/beneficiary identified on this form is alive on the date on which such benefits are paid and are credited to his or her account,

the Financial Institution agrees to repay and refund to the RSA, on demand, the full amount of any payments made to and received by

the Financial Institution after the date of death of the benefit recipient, regardless of whether the account listed on this Direct Deposit

Authorization contains sufficient funds for the refund. The Financial Institution further agrees to accept the certification of the RSA as

to the date of death of such payee as sufficient evidence in accordance with Section 2.10 of the 2012 NACHA Operating Rules and

Guidelines.

I, the undersigned, confirm that the identity of the above named retiree/beneficiary, account number, and type are true and accurate.

As the representative of the above named Financial Institution, I certify that the Financial Institution agrees to receive and deposit the

identified payments in accordance with the Master Agreement and pursuant to Section 3.6.4 of the 2012 NACHA Operating Rules and

Guidelines, and that the Master Agreement is applicable to all payments sent by the RSA to the Financial Institution for the benefit of the

retiree/beneficiary.

Representative Name _______________________________________________________________________________________

Representative Signature __________________________________________________ Date _____________________

Sign Here

Financial

Telephone ____________________________

Institution

Please return completed form to:

The Retirement Systems of Alabama

P.O. Box 302150

Montgomery, AL 36130-2150

Fax: 334.517.7001

Note: Direct Deposit Authorization forms that are processed after the 14 th of each month will become effective the following month.

RSA DDR

REV 4-16

Form Rsa Ddr - Rsa Direct Deposit Authorization - Alabama Page 2

Related Articles

Related forms

Related Categories