TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER aaa: PENSIONS
PART 4415 PAYMENT OF ANNUAL COMPLIANCE FEES FOR PENSION FUNDS
SECTION 4415.ILLUSTRATION B DESIGNATION FOR AUTOMATED CLEARING HOUSE PAYMENT OF COMPLIANCE ANNUAL FEES

Section 4415.ILLUSTRATION B   Designation for Automated Clearing House Payment of Compliance Annual Fees

 

Illinois Department of Insurance

Public Pension Division

 

Designation for Automated Clearing House

Payment of Annual Compliance Fees

 

Depository Name:

 

Account Name:

 

City:

 

State

 

Zip Code

 

Routing Transit Number of Depository Above:

 

Account Number to be Debited:

 

Authorized Pension Representative:

 

Phone Number:

 

Signed:

 

Dated:

 

 

(Source:  Amended at 30 Ill. Reg. 13176, effective July 24, 2006)