Ohio Direct Deposit Form 2

SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO
300 E. BROAD ST., SUITE 100 • COLUMBUS, OHIO 43215-3746
614-222-5853 • Fax 614-222-5828 • Toll-Free 800-878-5853 • www.ohsers.org
®
DIRECT DEPOSIT FORM
If your first day of retirement begins on or after Jan. 1, 2013, you must complete this form. Pensions are only paid
by electronic transfer to savings or checking accounts.
Recipient’s Name _________________________________________Social Security Number _____________________
Address _________________________________________________________________________________________
City__________________________ State ___________ ZIP ____________ Phone Number ______________________
Your pension payment will be available on the first of every month only by direct deposit. Your first, and possibly second,
pension check will be sent to your home.
Name of Bank ____________________________________________________________________________________
Address _________________________________________________________________________________________
City__________________________ State ___________ ZIP ____________ Phone Number ______________________
Choose one of the following:
Checking Account
Voided check must be attached.
Savings Account
Account Number ______________________________________
Nine-digit routing or transit number
Tape or staple a voided check here.
No deposit slip.
To fax this form, please attach voided check, and make a photocopy.
RECIPIENT’S SIGNATURE
I, the undersigned, authorize SERS to transmit my payments to the above-named financial institution; recover directly from
the financial institution any payments electronically deposited to my financial institution to which I am not entitled; and
authorize and direct my financial institution on my behalf or on behalf of my estate to refund such benefit overpayments to
SERS, and charge it accordingly to my account.
________________________________________________________
_____________________________________
RECIPIENT’S SIGNATURE (DO NOT PRINT)
DATE
5.124 Rev. 7/2012