Georgia Direct Deposit Form 1

*b2$*
Direct Deposit of Net Monthly Benefit
SECTION 1 - RETIREE INFORMATION
RETIREMENT PLAN TYPE (Mark X in Appropriate Box)
Employees’ Retirement System (ERS)
Public School Employees Retirement System (PSERS)
Georgia Legislative Retirement System (LRS)
Georgia Judicial Retirement System (GJRS)
Georgia Military Pension Fund (GMPF)
Georgia Defined Contribution Plan (GDCP)
Name: ___________________________________________________ SSN:
(Last)
(First)
(MI)
(Maiden)
Daytime Phone Number: (_____) __________________________ E-mail Address: _______________________________________
Mailing Address: ____________________________________________________________________________________________
(Street)
(City)
(State) (Zip Code)
Please update ERS system to reflect the above address.
SECTION 2 - DIRECT DEPOSIT AUTHORIZATION
INSTRUCTIONS:
Before signing this agreement, please read the special conditions on page 2.
I authorize the Employees’ Retirement System of Georgia to electronically deposit my net monthly benefit into my bank account. I have read and I understand the stipulations on the second page of this form, and I also understand that the following
conditions apply:
●My check can only be deposited into an account for which I am an account holder.
●ERSGA is authorized to adjust any entries made in error.
●This arrangement remains in effect until I cancel or change it in writing to ERSGA.
●I agree to immediately notify ERSGA of any change in my home address.
●Failure to abide by these conditions can jeopardize deposit of my monthly benefit.
__________________________________________
______________________________
Signature
Date
SECTION 3 - DIRECT DEPOSIT INFORMATION
INSTRUCTIONS:
Please check in the appropriate box indicating whether the account is a Checking Account or a Savings Account.
□ CHECKING
□ SAVINGS Please provide the following information:
A voided pre-printed check must be
attached. Starter checks will not be
accepted.
Financial Institution ___________________________________
Account Number ______________________________________
9-Digit Routing or Transit Number _______________________
SECTION 4 - ERSGA USE ONLY
Retirement Number: ______________________ B2 01/2009
Date Verified: ___________________ Page 1 of 2
Initials: ______
Employees’ Retirement System of Georgia
TWO NORTHSIDE 75
ATLANTA, GA 30318-7778
(404) 350-6300 (Atlanta)
1-800-805-4609 (outside the Atlanta area)
The following information should be read and understood before signing and returning this form for Direct Deposit.
Please call the ERSGA office if you need further clarification.
NOTICE
Joint Account Holders: Joint account holders must notify ERSGA immediately of the death of the recipient of this benefit. Funds deposited after the
death of the recipient are not legal and must be returned to ERSGA. ERSGA
will then calculate and determine any survivor rights or benefit payments.

EFFECTIVE STARTING DATE: If ERSGA receives your request by the 18th of the month, your Direct Deposit
starts on the last working day of the following month. Example: If your request is received on or before November
18th, Direct Deposit starts on the last working day of December. If the request is received after November 18th, Direct
Deposit starts on the last working day of January. Until then, your check will be sent to your mailing address.

FOR NEW RETIREES: A new retiree’s first check is mailed. The first month, ERSGA uses the voided check or
savings account information (requested on the front of this form) in a trial run - making sure that your check will be deposited into the correct account at the correct bank. Starting the second month after retirement, your check is directly
deposited into your bank. Your first check is sent to your mailing address.

STATEMENTS: No monthly check stubs are issued. A statement is issued with the first month of Direct Deposit
and whenever a change occurs in the amount of deposit.

DEPOSIT DATES: Checks are always deposited on the last work day of each month.

BANK OR ACCOUNT CHANGES: This deposit agreement continues until you notify ERSGA in writing to do
otherwise. If you change banks or accounts, you must complete and send in another Direct Deposit form with an
attached voided check. We must have this signed form for every account. Please remember that the ERSGA office
must have all changes by the 18th of the month for the change to take effect the following month. The first payment
after ERS receives and enters your account/routing changes will be a paper check.

ADDRESS CHANGES: You must notify this office of any change in your home address. We are required to
keep all files current.
B2 01/2009
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