1375 Virginia Drive, Suite 102
Ft. Washington, PA 19034
Phone 215-542-8211

 
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Don't Forget!

It's Your responsibility to update the Funds Office with any dependent changes - Birth of a child, Change in Marital Status, etc.

 

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Health Care Solutions Corporation
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HealthLine   866-955-IUOE
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PCN    800-366-0129
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Direct Deposit Authorization Form

I hereby authorize the International Union of Operating Engineers Pension Fund of Eastern Pennsylvania and Delaware to initiate electronic transactions to my account(s) at the financial institution(s) indicated below.

Please note that the percent (%) deposited must equal 100%


Deposit of Monthly Pension Benefit
The account listed below is my Checking Account.  I request that % of my net pension benefit be credited to this account.

Institution:
 
City State Zip Code
Transit/ABA Number: Account Number:
 


Please note that you must verify both your ABA Number and your Account Number with your bank.  Make sure you tell your bank branch that you are having funds electronically transferred.  This may change the ABA Number that we are to use.

The account listed below is my Savings Account.  I request that % of my net pension benefit be credited to this account.
Institution:
 
City State Zip Code
Transit/ABA Number: Account Number:
 
Please note that you must verify both your ABA Number and your Account Number with your bank.  Make sure you tell your bank branch that you are having funds electronically transferred.  This may change the ABA Number that we are to use.


Signature:*____________________________    Date:______________

* Please Hand-sign this area and mail the form to the address above

Social Security No.: (xxx-xx-xxxx)