Transcription of New York City
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New York City
Offi ce Use OnlyNew york CityPolice Pension Fund Serving the Finest START or CHANGE Electronic Fund Transfer (EFT) Retiree or PayeeDO NOT SUBMIT THIS FORM IF YOU ARE AN ACTIVE MEMBERM ember Information:Tax ID #: _____ Pension #: _____ SSN, Last 4 digits: _____ First Name: _____M: ___ Last Name: _____Address: _____City: _____ State: _____ Zip Code: _____Phone #: (_____) _____-_____ DOB: _____/_____/_____ Please check if this is a new addressPlease check one: Member OR Non-MemberAccount Information:Name of fi nancial institution: _____ABA/Routing # (required for any account type): _____Account Type: Checking SavingsAccount #: _____[PLEASE ATTACH AN UNSIGNED CHECK MARKED VOID] Request type: New ChangeORAcknowledgement:I authorize and direct the fi nancial institution designation herein to immediately refund any overpayments to the New york city Police Pension Fund ( PPF ), including all payments made by the PPF on or after the date of my death, and to
New York City Offi ce Use Only Police Pension Fund “Serving the Finest” START or CHANGE Electronic Fund Transfer (EFT) Retiree or Payee DO NOT SUBMIT THIS FORM IF YOU ARE AN ACTIVE
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