Aflac Direct Deposit Claim Form Details

Aflac Direct Deposit Online is a service that allows you to have your Aflac payments deposited directly into your checking or savings account. This service is available to all Aflac policyholders and can be used to pay both premiums and claims. With Direct Deposit, you can avoid the hassle of writing a check each month, and your money will be available to you as soon as it is deposited into your account. To enroll in this service, simply fill out the form on our website and we will take care of the rest. Please note that there is a small fee associated with this service. For more information, please visit our website or contact us at (800) 995-2372.

This information will allow you to understand better the details of the aflac direct deposit online before you start filling it out.

QuestionAnswer
Form NameAflac Direct Deposit Online
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesaflac direct deposit claim form, aflacgroup com claim forms, direct deposit form from aflac, aflac direct deposit for claims benefits

Form Preview Example

Ge n e r a l Accou n t Tr a n sa ct ion & D ir e ct D e posit Au t h or iza t ion

for AFL St ock Pla n Liqu ida t ion s For m

N a m e & Ad dr e ss a s Sh ow n on Accou n t :

La st Fou r D igit s of Socia l Se cu r it y or Ta x I D N o. : _ _ _ _ _ _ _ _

 

Accou n t N u m be r : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

D a y t im e ph on e n u m be r : ___________________________________

 

 

PARTI AL W I TH D RAW AL – CON TI N UE D I V I D EN D REI N V ESTM EN T SELECTI ON S:

Issue Stock Certificate for _______________________ Whole Shares

Sell

_______________________ Whole Shares

____________________________________

Shareholder Signature

FULL W I TH D RAW AL – TERM I N ATE D I V I D EN D REI N V ESTM EN T, BAN K D RAFT AN D D ED UCTI ON S SELECTI ON S:

Issue stock certificate for whole shares and sell fractional share

Sell all plan shares

____________________________________

Shareholder Signature

( You r f in a n cia l in st it u t ion m u st b e a m e m be r of t h e Au t om a t e d Cle a r in g H ou se ( ACH ) n e t w or k . )

Aflac Incorporated (the Company) is authorized to deposit the proceeds from the liquidation of my shares held in the AFL Stock Plan by electronic funds transfer to the financial institution account indicated by the A T T A CH E D V OID E D D O CU M E N T . The Company is authorized to initiate corrections to any amounts transferred in error and any claim against the Company or the financial institution involved is waived with respect to the operation of this service. The Company and the financial institution reserve the right to terminate this service at any time.

Th is in f or m a t ion w ill n ot be m a in t a in e d on y ou r a ccou n t . I t w ill be r e qu ir e d e a ch t im e y ou r e qu e st a dir e ct de p osit of fu n ds fr om a sa le of st ock fr om y ou r AFL St ock Pla n .

N OTE: Checks and/or deposit slips from financial institutions such as sa vin g s & loa n s, t r u st ba n k s, cr e d it u n ion s, and fe de r a l sa vin g s ba n k s do not always contain the correct information for ACH deposit. Please verify with your financial institution that the bank routing number and the bank account number shown on your attached voided document are the correct numbers to be used with the ACH Network.

In cor r e ct in for m a t ion w ill de la y t h e r e ce ipt of y ou r fu n ds.

Checking account – At t a ch a V oide d Ch e ck

Savings account – At t a ch a V oide d D e posit Slip

You r n e t pr oce e ds w ill be se n t t o t h e fin a n cia l in st it u t ion t h a t you spe cifie d 3 bu sin e ss da ys a ft e r t h e t r a de da t e . Be ca u se t h e fu n ds go t o t h e Fe de r a l Re se r ve for pr oce ssin g, ple a se a llow a n a ddit ion a l 1 – 2 bu sin e ss da ys for t h e ba n k t o cr e dit t h e fu n ds t o you r a ccou n t .

_______________________________________________________________

________________________________________________________

Bank routing number (ABA) if different from number on Voided Check

Signature of bank account holder

______________________________________________________________________________________________________________________________

N ot a r iz a t ion of Sh a r e h olde r Sign a t u r e ( s)

Notarized signatures of ALL SH AREH OLD ERS are required I F the name(s) on the financial institution account to receive funds is N OT EX ACTLY the same as the name(s) on your Aflac Incorporated stock account.

_____________________________________

____________________________________

Shareholder Signature

Shareholder Signature

Subscribed and sworn to before me

Subscribed and sworn before me

__________________________________________

_________________________________________

this ______day of ______________, 20__________

this _______day of _____________, 20_________

__________________________________________

_________________________________________

Notary Public (seal)

Notary Public (seal)

My commission expires:_______________________

My commission expires:______________________

FAX TH I S COM PLETED FORM TO SH AREH OLD ER SERV I CES 7 0 6 . 5 9 6 . 3 4 8 8

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