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The NYCERS F380 form is an essential document for individuals seeking to have their monthly retirement allowance directly deposited into their bank accounts through Electronic Fund Transfer (EFT). By completing this form, members authorize the New York City Employees' Retirement System to deposit their retirement funds automatically, ensuring timely access to their benefits. The form requires personal information, including the member's name, address, and contact details, along with specific banking information such as the bank name, account number, and routing number. It is crucial for members to attach a preprinted personal check or deposit slip, as this helps verify their account details. Additionally, the form includes instructions and conditions that members must understand before submission. A notary public or commissioner of deeds must acknowledge the member's signature, adding a layer of verification to the process. Members should be aware that the EFT will remain active until they provide written notice to cancel it. This streamlined process offers convenience, allowing retirees to receive their benefits without delay, while also outlining the responsibilities of both the member and the bank regarding any potential errors in fund transfers.

Preview - Nycers F380 Form

NYCERS USE ONLY

F380

 

Mail completed form to: *380* 30-30 47th Avenue, 10th Fl

Long Island City, NY 11101

Authorization for Electronic Fund Transfer (EFT) of Monthly

Retirement Allowance

Complete this form if you wish to have your NYCERS check automatically deposited into your bank (checking or savings) account by Electronic Fund Transfer (EFT). Be sure to read the instructions on the back of this form before submitting it to NYCERS. NOTE: If the address you provide on this form is different from your address in our system, the new address will become your official address in our records. Should you have any questions, please contact our Call Center at 347-643-3000.

Member Number OR

Pension Number

 

Last 4 Digits of SSN

 

Daytime Phone

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

First Name

 

M.I.

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Apt. Number

 

 

 

 

 

 

 

 

 

City

 

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

Provide the banking information below and attach a preprinted personal check or deposit slip or a copy of your checking or savings account bank statement. Your name must appear on the preprinted check or bank document and it must match the name in NYCERS' records exactly in order for us to process this request.

I wish to deposit my monthly retirement allowance in my

Checking or

Savings

account. I have read and understand the

conditions on page 2 of this form and hereby authorize NYCERS to send my monthly retirement allowance via EFT.

BANKING INFORMATION (please print):

 

Bank Name

Phone Number

Branch Address

 

City

 

 

 

 

 

 

 

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Account Number

 

 

Bank Routing Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Member

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This form must be acknowledged before a Notary Public or Commissioner of Deeds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

County of

 

 

 

On this

 

day of

 

 

 

2 0

 

, personally appeared

before me the above named,

 

 

 

 

 

 

, to me known, and known to

me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she

executed the same, and that the statements contained therein are true.

If you have an official seal, affix it

Signature of Notary Public or

 

 

Commissioner of Deeds

 

 

 

 

 

 

 

Official Title

 

 

 

 

 

 

Expiration Date of Commission

 

 

 

 

 

 

 

If payments are transferred in error by NYCERS, the bank will return such payments to NYCERS as authorized by the depositor. The bank also agrees to apply the same procedures described in 31 CFR 210 to such transfers, and agrees to reimburse NYCERS to the same extent as Federal agencies are reimbursed under 31 CFR 210.

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Page 1 of 2

NYCERS USE ONLY

F380

 

Mail completed form to: 30-30 47th Avenue, 10th Fl Long Island City, NY 11101

Filling out this form and submitting it to NYCERS authorizes:

1.The Office of the Comptroller of the City of New York, on behalf of the New York City Employees' Retirement

System (NYCERS) to send my monthly retirement allowance via Electronic Fund Transfer (EFT) to the bank* designated on this form for deposit in my account.

2.My bank: (a) to receive my monthly retirement allowance via EFT for deposit in my account AND

(b)to deduct from my designated account or deposits in my name at this bank all amounts transferred in error by NYCERS or any amounts sent after my death and to reimburse NYCERS to the extent of such deductions, applying the same procedures described in 31 CFR 210 to such transfers in error and reimbursing NYCERS to the same extent as Federal agencies are reimbursed under 31 CFR 210.

3.My heirs, my estate and designated beneficiaries of my monthly retirement allowance, respectively, to reimburse NYCERS for any

amount deposited in error after my death, in event that my account is closed or contains an insufficient balance to reimburse

NYCERS.

This EFT authorization will remain in effect until I have given written notice to NYCERS canceling the EFT.

* The bank you name must be a member of the Automated Clearing House in order for your funds to be deposited electronically.

HOW EFT WORKS:

1.Your net retirement allowance is automatically credited to your bank account on the last day of each month providing it's a business day; if the last day is a weekend or holiday, the funds are deposited on the next business day.

2.Your monthly net retirement allowance will appear on your bank statement.

3.A quarterly statement, issued by the Office of the Comptroller, will be mailed to your home address. It will reflect details of your monthly retirement allowance, including deductions for union dues, health insurance and federal income tax withheld during the three-month period.

Your monthly retirement allowance can be deposited in either your checking or savings account - NOT split between both.

TO AUTHORIZE EFT:

Provide your personal and banking information on page 1.

Attach a preprinted personal check

(name must appear on check) or preprinted savings deposit slip to this page. If your bank no longer provides personal checks or preprinted savings deposit slips, attach a copy of the top portion of your Checking or Savings Account Bank Statement.

If submitting a preprinted check or deposit slip write VOID (in large letters) across the face, as indicated in the sample.

Do NOT sign the check that you are attaching to this page.

The name on your bank account must match exactly your name in NYCERS' records.

Note: It may take up to 45 days from receipt of this form for the account to be processed for EFT.

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Page 2 of 2

Form Characteristics

Fact Name Details
Purpose This form authorizes the automatic deposit of monthly retirement allowances into a designated bank account via Electronic Fund Transfer (EFT).
Eligibility Members of the New York City Employees' Retirement System (NYCERS) can use this form to set up EFT for their retirement payments.
Bank Requirements The chosen bank must be a member of the Automated Clearing House to facilitate electronic deposits.
Documentation Members must attach a preprinted personal check, deposit slip, or a copy of their bank statement showing their name.
Processing Time It may take up to 45 days from the receipt of the form for the EFT setup to be completed.
Cancellation The EFT authorization remains in effect until the member provides written notice to NYCERS to cancel it.
Legal Compliance The form adheres to federal regulations under 31 CFR 210 regarding the handling of erroneous transfers and reimbursements.
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