Pbgc Form 706 - Beneficiary Application For Pension Benefits

Pbgc Form 706 - Beneficiary Application For Pension Benefits - 2006 Page 5

Form 706, page 5 of 5

Beneficiary Application for Pension Benefits - OF

Plan Number:

Participant Name / SSN:

Applicant Name / SSN:

6. Method of receiving benefit payments

How would you like to receive your payments?

MARK ONLY ONE

�

A. By Electronic Direct Deposit (EDD),

to the account identified below, which must have your

name on it.

�

B. By mail to my home address,

which is printed in section 1 of this form.

ou may choose this

option if you cannot use EDD because of physical, mental, geographic, language, or literacy barriers;

or if using EDD would cause you financial difficulties.

7. Financial institution information

–

Please provide the information in this section to have your payment sent

directly to a financial institution. The financial institution will receive and post credits and/or debits for you. You may cancel

or change this arrangement by calling PBGC at 1-800-400-PBGC. The financial institution can cancel it by sending you a

written notice.

The information below is available from your financial institution, or you may find it on your checks, account statement, or

deposit slip. There are three numbers printed on the bottom of your check: the financial institution’s routing number, your

account number, and your check number. The routing number must be nine digits. The first two digits must be 01 through

12 or 21 through 32. Your account number can be up to 17 characters (both numbers and letters). Include hyphens but

omit spaces and special symbols. Be sure not to use the check number. If you are unsure of the routing number or your

account number, contact your financial institution.

Name of Financial Institution

Branch

Mailing Address

City

State

Zip Code

Name of Contact Person

XTENSION

Routing Number

Financial Institution Phone Number

(

)

Name(s) on the Account

Account Type

��

Checking

Account Number

�

Savings

PLEASE REVIEW THIS FORM FOR REQUIRED SIGNATURES BEFORE YOU SUBMIT IT.

A MISSING SIGNATURE COULD DELAY YOUR FIRST PAYMENT.

THANK YOU

Pbgc Form 706 - Beneficiary Application For Pension Benefits - 2006 Page 5

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