EFT/Direct Deposit Cancellation Request Form (code BK19)

EFT/DIRECT DEPOSIT
CANCELLATION REQUEST FORM
(NOTE: Please print in black or blue ink, and initial any changes that you make on this form.)
PART A: All information must be provided.
First Name
MI Last Name Permanent Home Address
Social Security Number (last 4 digits only)
XX X X X
Apt. No. TRS Retirement/Beneficiary Number
City State Zip Code
Primary Phone Number (Check one:
(
)
Alternate Phone Number (Check one:
(
)
Home
Home
Work
Mobile)
Work
Mobile)
Please keep your personal information with TRS up to date. We will update our records based on the information you provide above,
so do not enter a temporary address; instead, TRS suggests that you consult the U.S. Postal Service about having your mail forwarded
on a temporary basis. To register any changes to your permanent address (and/or phone number), please access our website or file a
“Member’s Change of Address Form” (code DM13) or, if applicable, a “Beneficiary’s Change of Address Form” (code DM14) with TRS.
If you are providing new information above, please indicate the effective date:
• Please complete this form if you would like to cancel the Electronic Fund Transfer (EFT) or Direct Deposit of one or
both of the following: a) monthly retirement allowance payments under the Qualified Pension Plan (QPP); or b) monthly
annuity payments from the Tax-Deferred Annuity (TDA) Program. (To cancel EFT of payments made to two different
accounts, you must file a separate “EFT/Direct Deposit Cancellation Request Form” for each account.)
• Upon TRS’ receipt of this form, your EFT or Direct Deposit will be cancelled. The cancellation should take effect on the
first payroll that occurs 15-45 days after TRS receives this form. You would then receive paper checks each month for
retirement allowance and/or TDA annuity payments at the address you designated.
• Please note that TRS no longer permits members to enroll in the Direct Deposit system. Therefore, you may not
reinstate your Direct Deposit after filing this form; however, you may elect EFT for future payments.
• You may reinstate your EFT (or initiate EFT in place of Direct Deposit) after this form takes effect by filing an “EFT
Authorization Form” (code BK58) with TRS. Your EFT should begin 15-45 days after TRS’ receipt of your correctly
completed “EFT Authorization Form.”
• For your convenience, TRS forms and publications are available on our website. If you require additional assistance,
we encourage you to contact our Member Services Center at 1 (888) 8-NYC-TRS.
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PART B: Please provide the requested information below.
Financial Institution __________________________________________________________________________
Mailing Address _____________________________________________________________________________
City ________________________________________ State__________________ Zip Code _______________
Account Number (last 4 digits only):
Account Type:
Checking
Savings
PART C: Please check the type(s) of payment for which you would like to cancel your EFT/Direct Deposit.
QPP retirement allowance payments
TDA annuity payments
QPP beneficiary payments
TDA beneficiary payments
QPP QDRO payments
TDA QDRO payments
Other _________________________________________________________________________________
PART D: Please read the following statement and sign and date below.
I elect to cancel the EFT or Direct Deposit of monthly retirement allowance and/or TDA annuity payments to the financial institution
indicated in Part B. I understand that my EFT or Direct Deposit will be cancelled upon TRS’ receipt of this form, and that this
cancellation should take effect on the first payroll that occurs 15-45 days after TRS receives this form. I understand that, once my
EFT or Direct Deposit is cancelled, retirement allowance and/or TDA annuity payments will be sent to the address I have designated.
I also understand that I may not reinstate Direct Deposit of these payments. However, I may file an “EFT Authorization Form” to
resume or initiate EFT at any time after this form takes effect.
SIGNATURE ___________________________________________________________ DATE (M/D/Y) _______________________
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