Direct Deposit Req_TRS Form 278

*+278*
TEACHER RETIREMENT SYSTEM OF TEXAS
1000 Red River Street, Austin, Texas 78701-2698
Telephone (512) 542-6400 or 1-800-223-TRST (8778)
www.trs.state.tx.us
TRS278
Rev. 09-10
DIRECT DEPOSIT REQUEST
Name of Annuitant
To: Teacher Retirement System of Texas (TRS)
Social Security Number
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 below.
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 first 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 the financial institution shown below
and may not be available to me on the first 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.
If my death shall occur prior to the due date of any payment made by TRS in compliance with this request, the financial
institution will refund such payment to you in accordance with this agreement. This agreement shall not terminate upon my
disability.
I hereby authorize TRS to deduct 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
Mailing Address of Annuitant
%
City, State, Zip Code
(Area Code) Daytime Telephone Number
AGREEMENT TO BE EXECUTED BY FINANCIAL INSTITUTION
In consideration of the Teacher Retirement System of Texas (TRS) making payments in accordance with the
foregoing request concerning direct deposit of funds and without requiring the personal endorsement of the
annuitant on paper checks conveying each such payment and without requiring other proof that the annuitant
is alive on the date which such payment falls due, we hereby agree to repay and refund to TRS on demand, the
amount of any such payments made to us and received by us, the due date of which shall occur subsequently
to the date of death of such annuitant and we further agree to accept the certification of TRS as to the date of
death of such annuitant as sufficient evidence of date of death.
Financial Institution Transit Code
Account number is:
Must check one: checking
savings
Name and Mailing Address of Financial Institution
By:
Signature of Authorized Officer
Name of Officer (Print or Type)
City, State, Zip Code
Date Signed
Telephone No.
Title
Reverse of Form
TRS 278
Rev. 09-10
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.
INSTRUCTIONS
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 financial 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 and an authorized officer or representative of the financial institution must sign the TRS278 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.
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.
FINANCIAL INSTITUTION
The selected financial institution should complete all of the information requested. 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 the account and to recover erroneous payments from the account
holders. By signing this form, the financial institution agrees to accept the electronic transfer from TRS on behalf of the
annuitant and verifies the signature of the person as 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.
ATTACH A VOIDED PERSONALIZED CHECK HERE
PLEASE TAPE - DO NOT STAPLE