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Group Level Term Life Insurance EFT Authorization Form I would like the Administrator to deduct from my checking account the applicable premium contribution for my IEEE Group Level Term Life Insurance. I

My current IEEE Group Level Term Life Insurance Company is Wells Fargo Bank North America Corporation, N.A. (Account number: WFCN000189) Please provide your signature on the EFT Authorization Form, and a copy of the voided check or original check to be presented. I understand I can terminate this EFT Authorization Form and these future EFT deductions if you will not provide my name at such time and a written notice of the termination can be attached to this EFT authorization form. This EFT Authorization Form indicates that I authorize you, through the payment processing system operated by this Federal agency, the processing of my check in the amount of 100.00. This EFT Authorization Form represents the only agreement, express or implied, that your employer or any other person (e.g., payroll service provider, payroll and benefit administrator, etc.) will, at any time, have with me regarding payments received by my employer. The Federal agency's processing and storage of the payment will be considered noncompliance with federal law and regulation, and if any portion of this EFT Authorization Form is denied, the remainder of this EFT Authorization Form will be deemed valid and effective. I have attached a voided check for the checking account from which I want these future deductions made. In addition, I attach a copy of the voided payment and the original of the check that I requested, with my signature in the following font. Please sign to acknowledge this document and to authorize your use of it. By signing below, I acknowledge the following terms: (1) This check or original check is a final check, non-negotiable, and not a negotiable demand note. (2) This Agreement is entered into pursuant to the Federal Deposit Insurance Act, as amended, and no statement or demand from any person, including my employer, (or its agent) will relieve me from my duty to pay this payment. I want my EFT Authorization Form to be used only as authorized by me and be considered as in evidence, except as otherwise provided by law. Any violation of my rights herein will render this Agreement invalid and unenforceable.

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What is eft authorization form?

An EFT authorization form is a document that authorizes the transfer of funds electronically from one bank account to another.

Who is required to file eft authorization form?

Any individual or organization that wants to electronically transfer funds from their bank account is required to file an EFT authorization form.

How to fill out eft authorization form?

To fill out an EFT authorization form, you typically need to provide your bank account information, including the account number and routing number, as well as any additional information requested by the receiving party.

What is the purpose of eft authorization form?

The purpose of an EFT authorization form is to provide the necessary information and authorization to initiate electronic fund transfers between bank accounts.

What information must be reported on eft authorization form?

The information typically required on an EFT authorization form includes the account holder's name, bank account number, routing number, and any other relevant details specified by the receiving party.

When is the deadline to file eft authorization form in 2023?

The specific deadline to file an EFT authorization form in 2023 may vary depending on the circumstances and the organization requiring the form. It is recommended to consult the relevant party or refer to specific instructions for the exact deadline.

What is the penalty for the late filing of eft authorization form?

The penalty for late filing of an EFT authorization form can vary depending on the applicable regulations and the specific situation. It is advisable to consult the relevant authorities or the party requesting the form for accurate information on potential penalties.

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