Fill in a Valid Hawaii Direct Deposit Template Edit Form

Fill in a Valid Hawaii Direct Deposit Template

The Hawaii Direct Deposit form, officially known as Form ERS-210, is a crucial document for retirees and beneficiaries of the Employees’ Retirement System of the State of Hawaii. This form allows individuals to authorize the direct deposit of their retirement benefits into a designated financial institution. Completing this form accurately is essential to ensure timely and secure payments, so be sure to fill it out by clicking the button below.

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The Hawaii Direct Deposit form, officially known as Form ERS-210, plays a crucial role in ensuring that retirees and beneficiaries of the Employees’ Retirement System (ERS) receive their retirement benefits seamlessly. Established by legislation in 2010, this form mandates that all recipients designate a financial institution for direct deposit, effective April 1, 2011. Completing the form accurately is essential; all sections must be filled out for it to be valid. If any changes occur—such as a new account number or a different financial institution—a new form must be submitted. The process begins with Section A, where account holders authorize the ERS to deposit benefits directly into their chosen account. Section B requires specific account information, ensuring that the retiree’s name matches the account holder’s name. Section C outlines agreements that bind all account holders, emphasizing the collective responsibility for the account. Finally, Section D captures the signatures of all parties involved, confirming their understanding and acceptance of the terms. To facilitate the process, a voided check or deposit slip must accompany the form when submitted. For any inquiries, the ERS provides multiple contact options, ensuring that assistance is readily available to those navigating this important step in securing their retirement benefits.

Sample - Hawaii Direct Deposit Form

ERS-210

Act 94/SLH 2010 (Rev. 9/2011)

INSTRUCTIONS FOR

DIRECT DEPOSIT AGREEMENT (FORM ERS-210)

In 2010, the Hawaii Legislature passed a law, effective April 1, 2011, requiring all retirees and beneficiaries of the Employees’ Retirement System of the State of Hawaii ("ERS") to designate a financial institution into which the ERS shall be authorized to deposit their ERS retirement benefits.

All portions of the Direct Deposit Agreement (Form ERS-210) must be completed in order for the form to be valid. In addition, if there is any alteration of this form, a new form must be completed. You must submit a new form if there are any changes to your account (i.e. account number, account holder, financial institution). The most recently dated form submitted to ERS will apply.

Section A – Deposit Authorization

By signing the Direct Deposit Agreement, you and all account holders authorize the ERS to automatically and directly deposit your ERS benefits to the Financial Institution named in Section B.

Section B – Account Information

The retiree or beneficiary’s name must appear on the account. You may ask the representative of the financial institution to help complete this section.

Section C – Agreements of All Account Holders

This section contains the agreements of everybody who is on the account, including the ERS retiree or beneficiary. The agreements in Section C apply to all Account Holders even if they are not the retiree or beneficiary receiving ERS benefits.

Section D – Signatures of All Account Holders

By signing the Direct Deposit Agreement, all of the Account Holders confirm that they understand and agree to the agreements in Section C.

The retiree or beneficiary signs as primary account holder. If the account is a joint account, please have all account holder(s) sign the form. Use an additional sheet if necessary. If you are representing the retiree or beneficiary, please ensure that you have any authorizing document(s) attached to the Direct Deposit Agreement (Form ERS-210).

Please attach a VOIDED check (Checking Account) or deposit slip (Savings Account) and return this form to the ERS.

If you have any questions, please contact the ERS at:

Oahu:

 

(808) 586-1735

Toll Free from neighbor islands:

1-(800)

468-4644 Ext. 61735

Toll Free from mainland:

1-(888)

659-0708

ERS Website:

http://www4.hawaii.gov/ers

 

 

Mailing Address:

Employees’ Retirement System

 

 

 

201 Merchant Street, Suite 1400

 

 

 

Honolulu, HI 96813-2980

 

 

ERS-210

Act 94/SLH 2010 (Rev. 9/2011)

EMPLOYEES’ RETIREMENT SYSTEM OF THE STATE OF HAWAII

201 Merchant Street, Suite 1400

Honolulu, Hawaii 96813-2980

DIRECT DEPOSIT AGREEMENT

LAST Name:

FIRST Name:

Mailing

Address:

Check here if

new address

SSN:

Middle Initial:

Day Phone:

Effective April 1, 2011, Hawaii law requires all retirees and beneficiaries receiving benefits from the Employees' Retirement System of the State of Hawaii ("ERS") to designate a financial institution into which the ERS shall be authorized to deposit their ERS retirement benefits.

SECTION A – Deposit Authorization

By signing in Section D, I/We hereby authorize the Employees’ Retirement System of the State of Hawaii (“ERS”) to automatically and directly deposit my ERS benefits to my/our account at the financial institution named below (“Financial Institution”).

SECTION B -- Account Information (see your financial institution for help in completing this section)

Name of Account Holder(s):

Name of Financial Institution:

Routing Number:

 

 

 

 

 

 

 

Account Number:

 

□ Checking

□ Savings

 

 

 

 

Financial Institution Certification (Optional):

 

 

 

Name of Agent: ________________________________________

Phone: ___________________

Signature:

________________________________________

Date: _____________________

SECTION C – Agreements of All Account Holders

By signing in Section D, the Account Holder(s):

Authorize the ERS to make withdrawals from my/our account in the event that the ERS benefits have been deposited to the account in error, e.g., overpayments.

Consent to the disclosure by the Financial Institution to the ERS of any information that the ERS requests to effectuate, administer, or enforce the transactions authorized in Sections A, C, and D.

Agree not to hold the ERS responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me/us or by Financial Institution or due to an error on the part of Financial Institution in depositing funds to the account.

SECTION D – Signatures of All Account Holders

Authorized Signature (Primary):

Date:

Authorized Signature:

Date:

Please attach a VOIDED check (Checking Account) or deposit slip (Savings Account) and return this form to the ERS.

File Attributes

Fact Name Details
Legislative Requirement Effective April 1, 2011, Hawaii law mandates that all retirees and beneficiaries of the Employees’ Retirement System (ERS) designate a financial institution for direct deposit of their retirement benefits.
Form Validity To ensure the Direct Deposit Agreement (Form ERS-210) is valid, all sections must be completed. Any alterations require a new form submission.
Account Holder Agreements All account holders must agree to the terms outlined in Section C of the form, which includes authorizing the ERS to withdraw funds in case of erroneous deposits.
Contact Information If you have questions, you can reach the ERS at (808) 586-1735 or visit their website at http://www4.hawaii.gov/ers for more information.
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