ILLUSTRATION A - Designation for Fund Transfer for State Pension Fund for Payment of Annual Compliance Fee
Current through Register Vol. 46, No. 15, April 8, 2022
Illinois Department of Insurance Public Pension Division
Designation for Automated Clearing House Payment of Annual Compliance Fees
State Pension Fund Name: ________________________________________________
City:________________________ State ________________ Zip Code _____________
Fund Account Number to be Debited: _________________________________________
Fund Account Number to be Credited: _________________________________________
Amount of Transfer: _______________________________________________________
Requested Date of Transfer: ________________________________________________
Statutory Authority: ________________________________________________________
Authorized State Pension Fund Representative: _________________________________
Phone Number: __________________________________________________________
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