Form TRS278 - Direct Deposit Request

TRS 278
Rev. 09-15
*+278*
TEACHER RETIREMENT SYSTEM OF TEXAS
1000 Red River Street, Austin, Texas 78701-2698
Telephone (512) 542-6400 or 1-800-223-8778
www.trs.texas.gov
DIRECT DEPOSIT REQUEST
Name
Address:
Social Security No.
Street Address or Box Number
City
State
Zip Code
Telephone No.
ACCOUNT INFORMATION
Bank Routing Number
checking
Account number:
Name and Mailing Address of Financial Institution
savings
(Must check one)
City
State
Zip Code
To: Teacher Retirement System of Texas (TRS)
You are hereby requested to deposit the monthly payments, as well as other eligible payments, payable to me by the Teacher
Retirement System of Texas (TRS) directly to the financial institution shown above.
I understand that my payments will be transferred to my financial institution and credited to my account electronically, and
the funds for monthly payments will be available to me on the last business day of each month. I understand that the first
payment of my annuity after submission of this form may be a paper check mailed to my address on file and may not be
available to me on the last business day of the month.
I hereby reserve the right to cancel or change this request by written notice to TRS. I understand that it may take up to
45 days for the request to take effect. Additionally, I understand that if TRS is notified that my financial institution has
closed my account, TRS will mail my payments to my address on file with TRS until it receives new direct deposit
instructions.
This agreement shall not terminate upon my disability.
I hereby authorize TRS, through the Comptroller of Public Accounts, to reverse from the designated account or from
my subsequent payments all amounts deposited to the account in error. In the event my designated account is closed or
contains an insufficient balance to allow a deduction for amounts deposited in error, then I agree that TRS may withhold
any payments payable to me or, subsequent to my death, to my estate or to any beneficiary(ies) with an interest in my
account by TRS until such amount deposited in error is repaid. I hereby authorize the financial institution to disclose
information to TRS as indicated on the reverse side of this form.
* The following declaration MUST be completed by all annuitants requesting direct deposit of benefit payments.
Will these payments be transferred or forwarded outside of the United States?
Yes
No
If yes, to what country?
Percentage of monthly benefit to be transferred
Signature of Annuitant
%
Date Signed
Reverse of Form
TRS 278
Rev. 10-12
IMPORTANT NOTICE: This form is to be used only for the deposit of payments from the Teacher Retirement System
of Texas (TRS).
TRS through the Texas Comptroller of Public Accounts has the ability to electronically deposit an annuitant's monthly
benefit and certain other payments to an authorized financial institution. The financal institution may be any bank,
savings and loan association, or similar institution, or federal or state chartered credit union in which the annuitant has
a checking or savings account. In order for TRS to deposit the annuitant's payments into a financial institution, the
annuitant must sign the TRS 278 Direct Deposit Request form. Do not use this form if you intend to transfer your
entire monthly TRS benefit from the financial institution shown on the front side of this form to a foreign
country.
INSTRUCTIONS
ANNUITANT INFORMATION
The annuitant's name, social security number, mailing address, home telephone number, and work telephone number,
if any, should be typed or printed in the appropriate lines.
ACCOUNT HOLDER AGREEMENT
After reading the conditions of the depository agreement, the annuitant, annuitant's attorney-in-fact, or guardian of the
annuitant's estate must sign and date the form. If the attorney-in-fact signs the form on behalf of the annuitant, the
power of attorney document must be attached to the form. If a guardian signs the form on behalf of the annuitant, the
Order and Letters of Guardianship or other legal document must be attached to the form. If you have already provided
these legal documents and TRS has accepted them, you do not need to provide an additional copy with this form.
The monthly benefit may only be deposited in an account in which the annuitant has an interest. The routing number
should reflect the number for electronic transfers, which may be different from the routing number for the branch bank
at which the account is held. The annuitant, by signing this form, authorizes the financial institution to communicate
and disclose relevant information to TRS concerning the parties who have an interest in this account and to recover
erroneous payments from the account holders. By signing this form, the annuitant represents that the financial
institution agrees to accept the electronic transfer from TRS on behalf of the annuitant and verifies that the annuitant
is an individual having an interest in the account in which the TRS payments will be deposited.
TERMINATION OF DIRECT DEPOSIT AGREEMENT
This direct deposit agreement shall remain in effect until terminated by:
cancellation by the annuitant, attorney-in-fact, or guardian by written notice to TRS that
gives TRS a reasonable opportunity to act upon such notice; or
written notice from TRS to the annuitant indicating TRS's termination of the agreement; or
the closing of the account by the annuitant or authorized legal representative.
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A monthly annuity is payable to a TRS annuitant through the month in which the person dies. TRS is authorized by
law to send a final monthly payment of an annuity to a financial institution.
PLEASE ATTACH A VOIDED PERSONALIZED CHECK TO THIS FORM IN THE SPACE PROVIDED BELOW.
Your voided check helps TRS process payments faster and avoid errors.
ATTACH A VOIDED PERSONALIZED CHECK HERE
PLEASE TAPE - DO NOT STAPLE