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RETIREMENT- Roseville Police/Fire Retirement EFT Authorization

  1. Roseville Logo
  2. Electronic Funds Transfer Authorization

    City of Roseville Police & Fire Retirement System

    Sharon Maas
    586-447-4651

  3. FOREIGN FINANCIAL INSTITUTION DECLARATION
  4. DECLARATION-U.S. Law requires that the following information be obtained for all Direct Deposit (ACH) transactions.*

    Will the pension payment that is made via direct deposit pursuant to this Authorization be forwarded across the U.S. Border to a foreign financial institution thought the ACH network on the same day that it is deposited into your account?

  5. PERSONAL INFORMATION
  6. Name of Plan Sponsor:

    City of Roseville #089686

  7. DEPOSIT INFORMATION
  8. DEPOSIT #1 Account Type*
  9. If Pension is being deposited into only one account, please leave this field blank.

  10. Complete ONLY if you wish to have your Pension deposited into two different accounts each month

  11. DEPOSIT #2 Account Type*
  12. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    I certify that the information I have provided on this Electronic Transfer Authorization Form is correct and complete.  I understand that this Authorization will remain in effect until I submit written authorization to cancel or change the information contained herein.  I authorize and direct Comerica Bank to make the monthly pension payment payable to me under the CITY OF ROSEVILLE POLICE & FIRE RETIREMENT SYSTEM plan via the Automated Clearing House (ACH) system to the financial institution(s) and account number(s) named herein.

  13. Leave This Blank:

  14. This field is not part of the form submission.