Form 1226Revised 8/20/2015
This authority is to remain in full force and effect until the South Carolina Retirement Systems has received written notification from me (us) of its termination in such time and in such manner as to afford the South Carolina Retirement Systems and the financial institution indicated above a reasonable opportunity to act on it.
As required by Title 9 of the South Carolina Code of laws, payment of retirement contributionswill be initiated from the above bank account on the designated due date as indicated onforms 1244 and 1246. Forms must be received by 12:00 P.M. on the last business day beforethe due date. Forms received after this date will be considered late and debited the next business day. Delinquent payments require an interest assessment. Forms can be mailed in the greenAccounting Department envelope or faxed to 803-740-1255.
Authorized Signature :
Telephone Number :
Transit/ABA Number :
Authorization Agreement for Automatic Debits
SC Public Employee Benefit Authority
South Carolina Retirement Systems
P.O. Box 11960
Columbia, SC 29211-1960
financial institution named below, to debit and/or credit the same to such account.
savings account (select one) and the
entries and adjustments for any debit entries in error to our
I (we) hereby authorize the South Carolina Retirement Systems to initiate debit entries and to initiate, if necessary, credit
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