Sfn53879 2025

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25 votes

The document is an authorization form for direct deposit of annuity payments from the North Dakota Public Employees Retirement System (NDPERS). It requires participants to provide personal information, specify the amount and type of account for deposit, and consent to electronic fund transfers. Both the participant and their financial institution must complete the form, which remains effective until canceled in writing. The document outlines instructions for completion, cancellation procedures, and emphasizes that it does not authorize insurance premium withdrawals.

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Click ‘Get Form’ to open the sfn53879 in the editor.
In Part A, enter your full name, NDPERS Member ID, last four digits of your Social Security Number, and date of birth. This information is crucial for identification.
Specify the amount of benefit you wish to deposit by selecting either 100% or a specific percentage. If opting for a portion, fill in the percentage and dollar amount accordingly.
Indicate the type of account (checking or savings) and provide the corresponding account number. Ensure accuracy to avoid any issues with deposits.
Sign and date the form at the bottom of Part A to authorize the direct deposit arrangement.
In Part B, have your financial institution complete their section, including their name, address, account number, and routing number. They must also sign and date this section.
Once completed, retain a copy for your records and send the original form to NDPERS as indicated at the top of the document.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (35 Votes)
2020	4.3 Satisfied (44 Votes)
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