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Direct Deposit Authorization - CalPERS

Information About Your Account Section 1 Information About YouA separate form must You will receive a confirmation letter with the effective date once CalPERS has processed this completed form. In order be completed for each type to receive important information about benefits, payees should keep CalPERS informed of any address changes. of retirement benefit to be sent by Direct (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID( )Address Daytime PhoneCity State ZIP Code Section 2 If you are authorizing your c Checking c Savings c Individual c Joint (If so, Complete Section 3) c Trust Account *payment to your savings account or do not have Routing Number (nine digits) Account Number pre-printed, personalized checks, please have Please use tape to attach your voided, pre-printed personalized check.

Direct Deposit Authorization 888 CalPERS (or 888-225-7377) • TTY: (877) 249-7442 PERS-BSD-1199P (5/17) Page 1 of 2. www.calpers.ca.gov. ... Payroll deduction/state contributions 3. Billing of contracting agencies for employee/ employer contributions 4. Reports to CalPERS and other state agencies

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