[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-283887-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-283887-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","electronic-fund-transfer-eft-authorization-form-enrollment-changes-or-cancellation","Electronic Fund Transfer (EFT) Authorization Form - Enrollment, Changes, or Cancellation","","Electronic Fund Transfer (EFT) authorization instructions and form fields for enrolling in, changing, or canceling monthly net benefit deposits. It collects the payee’s personal details and, where applicable, the deceased certificate holder name for Survivor Income Benefits. The form requires a voided check or a deposit slip depending on checking or savings account, then requires signature and date. Processing typically takes 4–6 weeks, and the authorization specifies debit rules for erroneous deposits plus ongoing EFT validity until cancellation is submitted.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/electronic-fund-transfer-eft-authorization-form-enrollment-changes-or-cancellation/283887/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/electronic-fund-transfer-eft-authorization-form-enrollment-changes-or-cancellation/283887.png","ImageObject",442,249,{"name":42,"@type":43},"Aladdin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",19,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What documents are required to set up EFT for a checking or savings account?","Question",{"text":63,"@type":64},"For a checking account, include a voided personal check marked “void”. For a savings account, include a deposit slip if available.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"When should the deceased certificate holder’s name be included?",{"text":68,"@type":64},"Include the deceased insured name (“Certificate Holder”) only when receiving Survivor Income Benefits. Disregard it when receiving Disability Benefits.",{"name":70,"@type":61,"acceptedAnswer":71},"How long does it take to process the EFT authorization form?",{"text":72,"@type":64},"Allow 4 to 6 weeks to process the authorization form after it is signed, dated, and returned.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283887,1790234394,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social 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Benefits,please includethe name of the deceasedinsured(\"Certificate Holder\").  \n3.Be sure to include a voidedcheck (if requesting EFT to yourchecking account)ora depositslip(if requesting EFTto yoursavings account).  \n4.Sign,date and return theform.Please allow 4 to 6weeksto process your authorizationform.  \nCity:  \nRetain a completed copyfor your records.  \n## 5.Sign and date this authorization statement:\n\nSignature X  \n## 1.Please provide the following information:\n\nYour Name:  \nCertificate Holder's Name*:Address:City:State:Zip:Telephone No::area code(   )Policy/Plan No.:Social Security No.:  \n*Include the name of the deceased only if you are receiving Survivor IncomeBenefits(please disregard if you are receiving Disability Benefits).  \n## 2.Select type of transaction:\n\n□Request to enroll  \nChange the following information:  \nAccount Number  \n□Request to cancel  \nAccount Type  \nFinancial institution  \n3.Indicate type of account:  \n□Checking account (includeablankpersonal check marked \"void\")  \n□Savings account (includea deposit slip ifavailable)  \n4.Provide the following information:  \nName of Bank:  \nBranch Office:  \nState:  \nZip:  \nBranch Telephone No::  \nBank Account No.:  \nBank Routing No:(First nine digits of check code line)  \nI authorize the Insurer or Administrator of the policy/plan number identified above (\"Company\")to deposit mymonthly net benefit into the account and bank i have indicated above or such other acount as the bank or anysuccessor designates as my account.I also authorize you to debit my account for any deposits made in error.Iunderstand that the EFT service is only available for personal accounts,not business or corporate.I also understandthat the EFT service will stay in effect untill notify the Company of cancellation on the EFT service authorization form.Iaccept the responsibility to notify the Company if there are any errors in my account and will not hold the Companyliable if there are any errors or omissions in depositing benefit payments to my designated account.  \nDate               \n◎2021,New York Life Insurance Company,New York,NY.All rights reserved.NEWYORK LIFE and the New York Life boxlogo are registeredtrademarks of New York Life Insurance Company.Life Insurance Company of North America and New York Life Group Insurance Company of NY aresubsidiaries of New York Life Insurance Company.Connecticut General Life Insurance Company is not affiliated with New York Life Insurance Company.","cbCairCsCQ5t7Yhb","https://ap.wps.com/l/cbCairCsCQ5t7Yhb","pdf",444128,"English","# EFT authorization instructions\n## Enrollment, changes, or cancellation\n## Required account documents and processing time\n# Authorization details\n## Personal information and certificate holder (if applicable)\n## Transaction type selection\n## Account and bank information\n## Authorization statement and terms","[{\"question\":\"What documents are required to set up EFT for a checking or savings account?\",\"answer\":\"For a checking account, include a voided personal check marked “void”. For a savings account, include a deposit slip if available.\"},{\"question\":\"When should the deceased certificate holder’s name be included?\",\"answer\":\"Include the deceased insured name (“Certificate Holder”) only when receiving Survivor Income Benefits. Disregard it when receiving Disability Benefits.\"},{\"question\":\"How long does it take to process the EFT authorization form?\",\"answer\":\"Allow 4 to 6 weeks to process the authorization form after it is signed, dated, and returned.\"}]","Electronic Fund Transfer (EFT) Authorization Form - Enrollment, Changes, or Cancellation | PDF",1789621387]