Direct Deposit Authorization Form revised 10 10 14

SCREEN ACTORS GUILD-PRODUCERS PENSION PLAN
IMPORTANT NOTICE - DIRECT DEPOSIT/DEBIT CARD ENROLLMENT
The Trustees of the Screen Actors Guild Producers - Pension Plan (“Plan”) have implemented a Debit Card program
for participants who choose not to elect the Direct Deposit option for their checking/savings account. There are
numerous benefits to choosing the Direct Deposit option for both the Plan and for Plan participants. Please complete
the information below and return it along with proof of your account (a voided check or copy of a bank statement if
you are electing to go with a Direct Deposit), into your checking/saving account in the enclosed envelope.
DIRECT DEPOSIT AUTHORIZATION
Please complete this form for the purpose of depositing your monthly pension benefit directly into your U.S. bank account.
Personal Information
LAST NAME
FIRST NAME
SOCIAL SECURITY NUMBER
MIDDLE NAME
TELEPHONE NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
Account Information
NAME OF FINANCIAL INSTITUTION
TELEPHONE NUMBER OF FINANCIAL INSTITUTION
JOINT ACCOUNT
YES
JOINT ACCOUNT HOLDER(S), if applicable
NO
ENCLOSE ONE PROOF OF ACCOUNT BELOW:
TYPE OF ACCOUNT (Check only one)
(Check only one)
VOIDED CHECK*
CHECKING
BANK STATEMENT
ROUTING AND TRANSIT NUMBER
ACCOUNT INFORMATION (If necessary,
contact your Bank for this information)
Proof of account must include your name,
full account number and routing number
ACCOUNT NUMBER
SAVINGS
Proof of Account is required, please submit a voided check or copy of a bank statement.
* A voided check is a blank check, which has “VOID” written on it.
Important Notice: Your pension check will be mailed to your current address until the electronic deposit has been confirmed by your
financial institution. If the financial institution rejects your deposit, you will be notified immediately.
Check this box only if you are electing the Debit Card option provided through Skylight, for the deposit your
pension benefits.
Authorization Agreement
I/we hereby authorize the Screen Actors Guild - Producers Pension Plan to make direct deposits and, if necessary,
correct any such deposits by making adjustments to my account at the financial institution I/we have indicated on this
form. I/we understand that written authorization will be required to make any changes or to stop the direct deposits.
I/we hereby authorize and instruct said financial institution to refund to the Screen Actors Guild - Producers Pension
Plan an amount equal to any payments which, after my death, have been credited to my account and if applicable, to
charge my account accordingly.
Participant’s or Beneficiary’s Signature
Date
Joint Account Holder’s Signature (if any)
Date
P.O. BOX 7830 · BURBANK, CA 91510-7830 (818) 954-9400 or (800) 777-4013 PENSION FAX (818) 973-4467
S:\MasterForms\DirectDepositAuth_Revised 10/10/14