Form Sers 123 PDF Details

Form Sers 123 is an important form that must be filed in order to establish a new business. This form can be filed with the state or local government, and it is used to provide basic information about the company. The information on this form will help the government determine what regulations and taxes apply to the business. Filling out this form correctly is critical for setting up your business correctly. Make sure to consult with an attorney or tax professional if you have any questions about how to complete this form.

Before you decide to fill out form sers 123, you should find out more concerning the type of form you'll work with.

QuestionAnswer
Form NameForm Sers 123
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespa sers forms, sers direct deposit form, pa sers 123 form, sers pa gov forms

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DEFINED BENEFIT PLAN

DIRECT DEPOSIT OF PENSION PAYMENTS

Complete Part I. Attach a voided check for the account type selected in the payee agreement section. You may attach a voided check for a savings account if the savings account number is the same as your checking account number. If you do not attach a voided check, your financial institution must complete Part II. Send the completed form to the address below.

SERS will enter the effective date of this direct deposit instruction in the space provided and send you a copy. Your first payment after the effective date will be by check, mailed to your address on record, and a test transaction will be sent to your financial institution to ensure that everything works correctly. Once confirmed, your next payment will be deposited into your account. Monthly pension payments are deposited on the last working day of each month.

PART I - PAYEE AGREEMENT

Payee Full Name (First, MI, Last)

Payee SSN

Street Address

Telephone

City, State, Zip

Payee Type (Check one)

 

 

 

 

 

 

 

 

Member SSN (if Payee is not a SERS member)

 

 

SERS Member

 

 

Survivor/Beneficiary

 

 

Alternate Payee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Action to be taken (Check all that apply)

 

 

 

 

*DO NOT WRITE - SERS USE ONLY*

 

 

Start Direct Deposit

 

Change Account Number

 

 

Change Financial Institution

 

 

 

 

 

 

 

 

 

 

 

Account Type (Check one - if an account type is not selected, the benefit cannot be processed.)

This change will be effective __________

 

 

Checking (voided check must be attached)

 

 

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby authorize and request the Pennsylvania State Employees’ Retirement System (SERS) to direct my monthly pension payment to my account indicated in Part II below, and I further authorize the financial institution to credit the same account without responsibility for correctness of such amount. I hereby revoke all prior payment arrangements with SERS.

This authorization will remain in effect until I give written notice of its termination to SERS in such time and in such manner as to allow SERS a reasonable opportunity to act upon it. If I wish to change these instructions, I agree to notify SERS at least 60 days prior to the effective date of such change.

Payee’s Signature

Date

PAYEE - STOP HERE! (To deposit into a savings account, have your financial institution complete the remainder of this form.)

PART II - FINANCIAL INSTITUTION AGREEMENT

 

ACH Routing Number

 

 

 

 

 

Account Number

 

 

 

 

 

-

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Financial Institution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip

 

 

 

 

 

 

 

 

 

 

Title

In consideration of SERS making payments in accordance with this authorization without requiring other proof that the payee is alive on the date which such payment falls due, we hereby agree to repay, refund and/or reimburse to SERS, on demand, the amount of payments made to and received by us, the due date of which is after the date of death of the payee, to the extent that funds representing such payments remain on deposit with this financial institution at the time of certification of payee’s death by SERS, to this financial institution.

Authorized Signature

Direct Deposit of Pension Payments | SERS 123 | Rev: 11/1/2021

30 North 3rd Street, Suite 150 | Harrisburg PA 17101 | 1.800.633.5461 | www.SERS.pa.gov

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