Maryland Direct Deposit Form 1Maryland Direct Deposit Form 1
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MARYLAND STATE RETIREMENT AGENCY
120 EAST BALTIMORE STREET
BALTIMORE, MARYLAND 21202-6700

DIRECT DEPOSIT — ELECTRONIC FUNDS TRANSFER SIGN-UP FORM
If you need assistance in completing this application, telephone a retirement benefits specialist at 410-625-5555 or 1-800-492-5909.

SECTION I
To Be Completed by Payee

SECTION II
To Be Completed by Financial Institution

Directions for Payee:
1) Please read the instructions printed on the following page.
2) Complete SECTION I.
3) Provide this form to your financial institution so that they may
complete Section II.
* Advise the Maryland State Retirement Agency (SRA) of
change of home address to receive important information
regarding benefits and taxes.

Directions for Financial Institution:
1) Verify information in SECTION I.
2) Complete SECTION II.
3) Send completed form to: Maryland State Retirement Agency
ATTN: EFT Department
120 East Baltimore Street
Baltimore, MD 21202-6700
or fax to: EFT Department at 410-468-1700

A. SOCIAL SECURITY