Pension Reference:
Application for payment of pension in local currency by direct deposit to: USA
Part 1 - Personal Details
Forename: Family name:
Address:
Contact Telephone Number/ Email address:
Part 2 – Overseas Bank Details
Full Name of Bank or Financial Institution:
Full Address of Bank or Financial Institution:
Full name of account holder (as quoted on the bank account) Max 22 characters
Account Number
(Maximum 17 Alpha Numeric characters. No hyphens or slashes to be entered)
If your number is less than 17 digits, fill from the left and leave spaces at the right hand end
ACH Transit Routing Number
(9 digits, all numeric. No hyphens, slashes or characters to be entered – we are unable to pay via the
ABA routing method)
Account Type (0 = Checking Account, 1 = Savings Account)
Part 3 – Please sign below:
Signed: Date:
02/2011 V2 024USA
Xafinity Paymaster is the trading name of Paymaster (1836) Limited
Registered Office: Sutherland House, Russell Way, Crawley, West Sussex RH10 1UH
Registered in England and Wales No. 3249700
Paymaster (1836) Limited is authorised and regulated by the Financial Services Authority
A Xafinity Limited Company