Form Lbl-1487lc - Lincoln Benefit Life Company Authorization For Direct Deposit Of Commissions

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We are able to process a direct deposit of your commission check into your checking or savings account! This
service has several advantages. First and foremost, you should receive your commissions faster! The funds
would be in your account the Monday after the finance cycle. For example, with a normal Tuesday cutoff, we
would mail these statements out of the office on the following Monday. With Direct Deposit, we would still mail
your regular commission statement on Monday, but the funds would be deposited into your account on
Monday as well! Deposit and mailing days may alter due to holidays.
To enroll in Direct Deposit, simply complete the form below and mail or fax it to the Licensing and Appointing
Department. Please note that if your commissions are assigned, you will need to have the assignee complete
the authorization form. Once we have received and processed the necessary information, it will take
approximately 10 days to verify the correct information is being sent through ACH. Therefore, once enrolled,
you will still receive one, or potentially two paper checks during the waiting period.
To enhance this service even further, we can also fax you notification of your deposit amount before it is
placed in your account. Due to the confidential nature of this information, this service will be optional. If you
want to receive this fax notification, please indicate your fax number on the Direct Deposit Authorization Form.
If you have any questions while completing this form, please contact the home office at (800) LBL-WATS.
Lincoln Benefit Life Company
Authorization For Direct Deposit of Commissions
Contract Name: ______________________________________________________ LBL Agent #:_________________
Fax # (for optional pre-deposit notification):__________________________________ Tax ID#:____________________
Institution Name: _________________________________________________________________________________
Institution Address:________________________________________________________________________________
Type of Account:
Account #:____________________________________________
Bank Routing #:________________________________________
I authorize and request Lincoln Benefit Life Company to direct the net amount of any payment to me for crediting in my account at the
financial institution designated above. "Payment" means any compensation payable to me under the terms of my contract. This
authorization is not an assignment of my rights to receive such payment and revokes all prior payment direction notifications applicable
to any such payment. I understand that the financial institution designated above reserves the right to cancel this agreement by notice
to me; however, this authorization will remain in full force and effect with Lincoln Benefit Life Company until Lincoln Benefit Life
Company has received written notification from me of its termination in such time and in such manner as to afford Lincoln Benefit Life
Company a reasonable opportunity to act upon it or until my agent status with Lincoln Benefit Life Company is terminated.
Please return this form to Lincoln Benefit Life Company - Attn: Licensing and Appointing
2940 South 84
Lincoln, NE
Fax: 402-328-6139
LBL-1487LC, Rev. 02/08


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