Rev. 10/17
Public Employees’ Retirement System of Nevada
693 W. Nye Lane, Carson City, NV 89703 (775) 687-4200 Fax (775) 687-5131
5740 S. Eastern Avenue, Suite 120, Las Vegas, NV 89119 (702) 486-3900 Fax (702) 678-6934
Toll free 1-866-473-7768 Website: www.nvpers.org Email: nvpers@nvpers.org
Electronic Funds Transfer (EFT) Authorization
Please print in blue or black ink.
Your Name
Social Security Number: Phone: ( )
Please select ALL ACCOUNTS to which these EFT instructions are to be applied:
□ Your Retirement Benefit □ Beneficiary/Survivor Benefit □ Alternate Payee Benefit
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All properly completed EFT forms must be received by our office by the 14
th
of the month to allow for
processing. Contact your bank if you need assistance with the completion of this form.
EFT Process: In the first month you start direct deposit or change your bank information, PERS will attempt to
verify your direct deposit instructions by submitting a test “prenote” file to your bank. If no corrections are
reported, the direct deposit will start on the date you indicate below. Otherwise, a paper check will be sent to
your home address on file.
Start Date / (A paper check may be mailed to you for this month)
Month Year
Name of My Bank
Bank Mailing Address
Street City Zip Code
Bank Phone Number (______)
Bank Routing Number ____________________________________________________ (9 Digit Number)
Bank Account Number ____________________________________________________ Checking Savings
(Choose only one)
I have read and understand the EFT process listed above. I authorize the Public Employees’ Retirement System
of Nevada (PERS) to send an EFT of my monthly retirement benefit to the account number I have provided. I
also authorize my bank to credit the deposit amount to the designated account. If any deposits are made in
error, I authorize and direct my bank on my behalf and, on behalf of my executors or administrators, to return
such deposits to PERS. I understand that PERS cannot send a direct deposit to a trust account or any
account which does not have my name on it.
Your Signature Date
Signature of Joint Account Holder (Required for all joint accounts) Date
Return completed form to the Public Employees’ Retirement System, 693 W. Nye Lane, Carson City, Nevada 89703
