Sedgwick Direct Deposit Form PDF Details

If you are a Sedgwick employee, you may be interested in using the direct deposit form to have your paychecks deposited directly into your bank account. This can save you time and hassle, and it is also more secure than carrying around large sums of cash. In this article, we will explain how to complete the Sedgwick direct deposit form and what information you will need to provide. We hope that this information will be helpful for you.

You will see details about the type of form you wish to fill out in the table. It will show you the span of time you'll need to finish sedgwick direct deposit form, exactly what fields you will need to fill in and some other specific facts.

Form NameSedgwick Direct Deposit Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesdirect deposit form asrs, direct deposit authorization asrs print, asrs disability, az deposit asrs disability online

Form Preview Example

ASRS Long Term Disability

Direct Deposit Authorization Form

PART 1: To be Completed by Employee




First Name _____________________Middle Initial_______ Last Name___________________________




I authorize Sedgwick and my Employer, at their discretion, to deposit my approved disability benefit payments into my account as indicated below.

This authorization will remain in effect until I give written notice to Sedgwick either to change or cancel this authorization, in such time and in such manner as to afford Sedgwick a reasonable opportunity to act on it. I understand that my deposit will not be posted to my account until the date of my monthly benefit payment.

I have provided Sedgwick with my financial institution information solely for the purpose of verifying my account number and transit/routing information.

I grant Sedgwick and my Employer the right to correct any Electronic Funds Transfer resulting from erroneous overpayment by debiting my accounts to the extent of such overpayment. I further understand that Sedgwick or my Employer is not responsible for any costs or service charges incurred by me as a result of Sedgwicks actions related to Electronic Funds Transfer.

Action Requested

Please establish a NEW direct deposit to the bank and account listed below.

Please CHANGE my direct deposit, and direct my benefit payments to the bank and account listed below.

Please CANCEL the direct deposit of my benefit payments to the bank and account listed below and send my benefit payment check to me in the mail.

Employee SignatureDate

PART 2: Financial Institution Information

Name of Financial Institution:

Routing #:













Telephone #: (













Account #:













Type of Account:





















After completing this form, please fax it to Sedgwick at (855) 800-5116 or mail it to Sedgwick, PO Box 14648, Lexington, KY 40512. Sedgwick only needs one copy of this form, so please choose one method of delivery only.

For Sedgwick Use Only

Prenote Completed By: ___________________________________________________ Date: ________________________

Sedgwick Direct Deposit Form 2015

Watch Sedgwick Direct Deposit Form Video Instruction

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