Form Rs 6370L 3 PDF Details

The New York State Comptroller Thomas P. DiNapoli oversees a crucial service for pensioners through the New York State and Local Retirement System, encompassing both the Employees’ Retirement System and the Police and Fire Retirement System. Located at 110 State Street, Albany, New York, this office facilitates a smoother, safer method for retirees to receive their benefits through the Electronic Funds Transfer Direct Deposit Enrollment Application, known as form RS 6370L-3. This form, subject to revision in July 2009, is a testament to the ease and security direct deposit offers. It mandates retirees to provide meticulous personal and banking information to ensure the accurate and timely deposit of their benefits into their chosen accounts, be it a savings or a checking account. Additionally, it encompasses directives for both the pensioner and the financial institution to adhere to, including the necessary authorization for recovering funds in case of erroneous payments. This arrangement not only signifies an advancement towards modern financial methods but also embeds a layer of financial security and convenience for pensioners, ensuring that their benefits are directly deposited into their accounts without the traditional wait times or risks associated with physical checks.

QuestionAnswer
Form NameForm Rs 6370L 3
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys retirement form rs 6370, PENSIONER, pleaseprint, rs 6370 printable form

Form Preview Example

Office of the New York State Comptroller

Thomas P. DiNapoli

New York State and Local Retirement System

Employees’ Retirement System

Police and Fire Retirement System

110 State Street, Albany, New York 12244-0001

Phone: 1-866-805-0990 or 518-474-7736 Fax: 518-402-4433

Email: nyslrsinfo@osc.state.ny.us Web: www.osc.state.ny.us/retire

Electronic Funds Transfer

Direct Deposit Enrollment Application

RS 6370L-3 (Rev. 7/09)

Date stamp:

SECTION 1. TO BE REVIEWED AND CORRECTED BY PENSIONER

Name: _______________________________________ Soc. Sec. #: __________________________ Retirement #:

Address:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Home Telephone: (______) ______________________ (Please Provide)

Registration #: ________________________________________

SECTION 2. TO BE COMPLETED BY PENSIONER

I hereby request all future benefits which become payable to me from the New York State and Local Retirement System (NYSLRS) be transferred to my account via Electronic Funds Transfer (EFT) Direct Deposit to:

Name of Financial Institution: ____________________________________________________________________________________________

Account Type:

o Checking (attach voided check to Section 3, or have Section 3 completed by your financial institution)

If your checks do not have your name imprinted on them, Section 3 must be completed by the financial institution.

o Savings (Section 3 must be completed by financial institution.)

NYSLRS is authorized to continue making such benefit payments to said financial institution or any of its successors until NYSLRS receives written notice from me to the contrary. I agree the NYSLRS shall have no liability or responsibility for loss occasioned by erroneous information supplied by myself, my duly authorized representative, or the financial institution.

I expressly acknowledge and understand any payments made pursuant to this request will be strictly an accommodation made to me by NYSLRS. NYSLRS reserves the right to discontinue or decline to honor this EFT request without prior notice.

I hereby authorize and direct the financial institution, on my behalf, my joint account holder, if any, and my estate to charge my account for amounts paid to which I was not entitled. I also agree, on behalf of myself, my joint account holder, if any, and my estate, that such amounts will be returned to the NYSLRS.

By making this request, I hereby represent the account identified herein (and as may later be modified) is not a trust held for the benefit of another.

Signature:______________________________________________________________________________

Date: ________________________

Signature of Joint Holder (If any): __________________________________________________________

Date: ________________________

SECTION 3. TO BE COMPLETED BY YOUR FINANCIAL INSTITUTION IF DIRECTING FUNDS INTO A SAVINGS ACCOUNT OR IF A VOIDED CHECK IS NOT ATTACHED. THE ABOVE PENSIONER’S NAME MUST APPEAR ON THE ACCOUNT.

(Attach a preprinted voided check with your name imprinted on check here)

Account Type:

 

o Savings

o Checking

 

 

 

 

 

Transit/ABA Number (ACH Format)

Depositor’s Account Number (EFT Format)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Financial Institution: ____________________________________________________________________________________________

Address:Telephone: ( ______ _) ____________________________

City:________________________________________________________ State: _______________________ Zip Code: ___________ - ______

I, as representative of the above named financial institution, agree to abide by the NACHA Rules and Regulations. Amounts paid to the account holder to which he/she is not entitled will be returned to NYSLRS. Liability shall be limited as prescribed in Section 4.7 of the NACHA Rules and Regulations.

Bank Officer Signature: _____________________________________________________Title: _______________________________________

Bank Officer (please print): __________________________________________________

PLEASE SEE BACK FOR INSTRUCTIONS

PLEASE READ CAREFULLY

Enrollment Application

The Electronic Funds Transfer Direct Deposit Enrollment Application must be signed by you and the joint account holder if any. If you are requesting direct deposit to a “Checking Account,” review Section 1 and make any necessary corrections, complete Section 2, then attach a voided check to Section 3. If a voided check is not attached to Section 3, or if your checks do not have your name imprinted on them, then Section 3 must be completed by your financial institution. Return the application to the New York State and Local Retirement System (NYSLRS). If requesting direct deposit to a “Savings Account,” Section 3 must be completed by your financial institution before you return the application to the NYSLRS.

Pensioner and Joint Account Holder Authorization For Recovery of Funds Deposited in Error

By signing this Electronic Funds Transfer Direct Deposit Enrollment Application, you, both for yourself and your estate, and each joint account holder, if any, consent to allow NYSLRS, through the designated financial institution, to debit your account in order to recover any NYSLRS benefits to which you were not entitled. This means of recovery shall not prevent the NYSLRS from utilizing any other lawful means to retrieve NYSLRS benefit payments to which you were not entitled.

Changing Financial Institutions and/or Accounts

You may change financial institutions and/or accounts by completing a new enrollment application. The new enrollment application, when processed, will cancel the enrollment at the previous financial institution or your prior account. You should, however, be aware that changing financial institutions and/or accounts could take up to

30 days to complete. We recommend that the old account not be closed until the first deposit is made to your new account or financial institution.

Cancellation of Electronic Funds Transfer Direct Deposit

To cancel this request, written notification from you must be received by the NYSLRS at least 30 days prior to the next payment date.

The financial institution may terminate the electronic funds transfer direct deposit agreement with a written notice 30 days in advance of the cancellation date. The financial institution cannot cancel the authorization without notification to both you and NYSLRS.

The New York State and Local Retirement System reserves the right to discontinue or cancel this electronic funds transfer direct deposit agreement at any time. Written notice will be provided to you.

The completed applications should be returned to the following address:

EFT/Pensioner Services

New York State and Local Retirement System

110 State Street

Albany, New York 12244-0001

Questions or problems should be directed to the address above or you may call us at (518) 474-7736 or toll-free at 1-866-805-0990.

How to Edit Form Rs 6370L 3 Online for Free

This PDF editor allows you to create forms. There's no need to do much to update PENSIONER forms. Only stick to the following actions.

Step 1: Click on the button "Get Form Here".

Step 2: The file editing page is now open. It's possible to add information or manage current data.

The following sections will constitute the PDF document that you'll be filling in:

part 1 to completing osc

Make sure you submit the By making this request I hereby, Signature Date, Signature of Joint Holder If any, SECTION TO BE COMPLETED BY YOUR, Attach a preprinted voided check, Account Type, o Savings o Checking, TransitABA Number ACH Format, Depositors Account Number EFT, Name of Financial Institution, Address, Telephone, City State Zip Code, and I as representative of the above box with the necessary particulars.

part 2 to finishing osc

Step 3: Click the button "Done". Your PDF form can be transferred. You will be able save it to your computer or email it.

Step 4: Come up with at least a couple of copies of the document to keep clear of any specific possible concerns.

Watch Form Rs 6370L 3 Video Instruction

Please rate Form Rs 6370L 3

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .