Mail completed form to:
30-30 47th Avenue, 10th Fl
Long Island City, NY 11101
Filling out this form and submitting it to NYCERS authorizes:
1.The Office of the Comptroller of the City of New York, on behalf of the New York City Employees' Retirement
System (NYCERS) to send my monthly retirement allowance via Electronic Fund Transfer (EFT) to the bank* designated on this form for deposit in my account.
2.My bank: (a) to receive my monthly retirement allowance via EFT for deposit in my account AND
(b)to deduct from my designated account or deposits in my name at this bank all amounts transferred in error by NYCERS or any amounts sent after my death and to reimburse NYCERS to the extent of such deductions, applying the same procedures described in 31 CFR 210 to such transfers in error and reimbursing NYCERS to the same extent as Federal agencies are reimbursed under 31 CFR 210.
3.My heirs, my estate and designated beneficiaries of my monthly retirement allowance, respectively, to reimburse NYCERS for any amount deposited in error after my death, in event that my account is closed or contains an insufficient balance to reimburse
This EFT authorization will remain in effect until I have given written notice to NYCERS canceling the EFT.
* The bank you name must be a member of the Automated Clearing House in order for your funds to be deposited electronically.
HOW EFT WORKS:
1.Your net retirement allowance is automatically credited to your bank account on the last day of each month providing it's a business day; if the last day is a weekend or holiday, the funds are deposited on the next business day.
2.Your monthly net retirement allowance will appear on your bank statement.
3.A quarterly statement, issued by the Office of the Comptroller, will be mailed to your home address. It will reflect details of your monthly retirement allowance, including deductions for union dues, health insurance and federal income tax withheld during the three-month period.
Your monthly retirement allowance can be deposited in either your checking or savings account - NOT split between both.
TO AUTHORIZE EFT:
•Provide your personal and banking information on page 1.
•Attach a preprinted personal check
(name must appear on check) or preprinted savings deposit slip to this page. If your bank no longer provides personal checks or preprinted savings deposit slips, attach a copy of the top portion of your Checking or Savings Account Bank Statement.
•If submitting a preprinted check or deposit slip write VOID (in large letters) across the face, as indicated in the sample.
•Do NOT sign the check that you are attaching to this page.
•The name on your bank account must match exactly your name in NYCERS' records.
Note: It may take up to 45 days from receipt of this form for the account to be processed for EFT.