TYPE OF PAYMENT

 

 

 YOUR NAME (Last, First MI)

DIRECT DEPOSIT AUTHORIZATION

FOR PROCESSING FEDERAL NET PAYMENTS

(Refer to instructions for preparing authorization before completing the form.)

SECTION 1 - RECIPIENT INFORMATION

 YOUR SOCIAL SECURITY NUMBER 

SECTION II - ACCOUNT INFORMATION

 TYPE OF ACCOUNT

 YOUR HOME TELEPHONE NUMBER YOUR WORK TELEPHONE NUMBER

 YOUR HOME / CORRESPONDENCE ADDRESS

COMMUNITY PROPERTY

CHILD SUPPORT

ALIMONY

CHECKING

SAVINGS

NOTE: IF YOU SELECTED A CHECKING ACCOUNT, A VOIDED PERSONAL CHECK OR SHAREDRAFT

MUST BE ATTACHED, IN ADDITION TO COMPLETING ITEMS 8 THROUGH 12 OF THIS SECTION. SEE

INSTRUCTIONS ON THE BACK OF THIS FORM.

 ROUTING TRANSIT NUMBER 

 ACCOUNT NUMBER

 ACCOUNT TITLE (Account Holder's Name)

 FINANCIAL INSTITUTION NAME AND ADDRESS

SECTION III AUTHORIZATION

 RECIPIENT'S SIGNATURE

 DFAS-CL FORM 1059, FEBRUARY 02 (FF) (Replaces DFAS-CL 7330/2)

DATE (YYYYMMDD)

 RETIREE'S SOCIAL SECURITY NUMBER
 NAME OF DEPOSITOR

 STREET ADDRESS

 CITY, STATE, ZIP CODE

 _________________ 20_____

 PAY TO THE

 ORDER OF ____________________________________________________________________________

 _______________________________________________________________________________________________ DOLLARS

 NAME OF YOUR BANK

 Payable Through Another Bank

 For ______________________________________________ _____________________________________________

 

 

 

 

 99999999 9 000 000 000 0101

8

 

 ACCOUNT NUMBER - Include dashes where the symbol appears on your check or deposit slip. Be sure not to

include the check number (#101 in the example) or deposit slip number as part of your Account Number in Item 9.

 If you cannot determine your Account Number, contact your financial institution.

ROUTING TRANSIT NUMBER - Examine your deposit slip or check for items labeled 9 in the above sample. Is

the Routing Transit Number (RTN) eight numbers in a row followed by a space and then one number? Is the first

number of the RTN "0," "1," "2," or "3"? If the answer to both questions is "yes" enter the numbers from your

deposit slip or check on the reverse of this form in Item 9. Otherwise, call your financial institution and ask them

to provide you with their RTN. 

PRIVACY ACT STATEMENT

Collection of the information you are requested to provide on this form is authorized under 31 CFR 209 and/or 210. The information is

confidential and is needed to prove entitlement to payments. The information will be used to process payment data from the federal agency to

the financial institution and/or its agent.

INSTRUCTIONS FOR PREPARING AUTHORIZATION

PURPOSE - You may use this form to provide instructions for processing your net pay. Failure to provide the requested

information may affect the processing of this form and may delay or prevent the receipt of payments through the Direct

Deposit / Electronic Funds Transfer Program. 

SECTION I - EMPLOYEE / MEMBER / ANNUITANT INFORMATION (ITEMS 1-5)

You must complete all blocks after carefully reading the instructions and Privacy Act Statement. You must keep the agency

informed of any address change to remain qualified for payments.

SECTION II - DIRECT DEPOSIT ACCOUNT INFORMATION

ITEM 6 - TYPE OF ACCOUNT - Place "X" in the appropriate box, to indicate if you want your payment to be sent to a 

 checking or savings account.

ITEM 7 - TYPE OF PAYMENT - Place an "X" in the appropriate box to indicate what type of payment you want sent by Direct 

 Deposit.

ITEM 8 - ROUTING TRANSIT NUMBER - Your financial institution's 9-digit routing transit number. See the illustration below.

ITEM 9 - ACCOUNT NUMBER - Your account number at your financial institution. See the illustration below.

ITEM 10 - ACCOUNT TITLE - The depositor's name on the account at the financial institution. See the illustration below.

ITEM 11 - FINANCIAL INSTITUTION NAME / ADDRESS - The institution to which payments are to be directed

 See the illustration below.

$

10

9 CHECK NUMBER

SECTION III - AUTHORIZATION 

ITEMS 12 AND 13 - You must sign and date this form before the authorization can be processed.

FOR CANCELLATIONS - This authorization will remain in effect until you cancel by providing a written notice to the DoD

Agency or by your death or legal incapacity. Upon cancellation, you should notify the receiving financial institution. The

authorization may be cancelled by the financial institution by providing you a written notice 30 days in advance of the

cancellation date. You must immediately advise the DoD Agency if the authorization is cancelled by the financial institution.

The financial institution cannot cancel the authorization by advice to the Government Agency.

FOR CHANGES - You must complete and submit a new "Direct Deposit Authorization" form to the applicable DoD agency. We

recommend that you maintain accounts at both financial institutions until the new institution receives your Direct Deposit

payments.

DFAS-CL Form 1059, FEBRUARY 02 (FF) (Replaces DFAS-CL 7330/2)

11

101

ACCOUNT TITLE - Must include recipient's name.

FINANCIAL INSTITUTION NAME / ADDRESS - If your check or sharedraft includes "Payable Through" under the

bank name, contact the financial institution to help obtain the correct Routing Transit Number for Direct Deposit.

8 -

9 -

10 -

11 -