Direct Deposit Enrollment Form

Annuity & Retirement Services
Direct Deposit Enrollment
Use this form to request electronic deposit of payments to your account.
Things to know before you begin
• You will need your bank account and routing numbers, and the bank
address and telephone number to complete this form.
• MetLife does not accept banking information for non-U.S. banks.
• If you have more than one benefit, you can list multiple Annuitant
ID numbers and we’ll apply the change to the records you request.
• If you’re making this request as a legally approved third party
(Power of Attorney, Guardian, etc.) and we don’t already have
your information on file, you’ll need to include documentation to
support your authority to request the change.
You must complete this entire form and sign where
indicated or your request may be delayed.
SECTION 1 – My Current Information (Please print.)
First Name
Middle Name
Last Name
Street Address
City
State
Email
Telephone Number
Social Security Number (last 4 digits)
Date of Birth (mm/dd/yyyy)
ZIP Code
Annuitant ID
SECTION 2 – My Account Information
•
•
•
Please provide the information requested for the bank where you have your account.
The sample check shown on the back of this form may help you locate your checking account numbers. Please note that you
must reference a copy of a check and not a deposit slip.
If a savings account is used, please check with your bank representative for the appropriate routing and account numbers.
Bank Name
Bank Telephone Number
Bank Street Address
City
Type of Account (check one): 
 Checking
BACH
State
ZIP Code
 Savings
CBF-ARS-BACH-SS (10/13) Fs
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Be sure to confirm the type of account as well as the account and
routing numbers with your bank to ensure prompt processing.
Bank Account Number
Bank Routing Number
SECTION 3 – Authorization & Signature
•
•
•
I request MetLife to send my payments to the financial institution designated in Section 2 for deposit into my account. This
agreement will remain in effect until MetLife receives notice from me to the contrary.
I understand that MetLife will not be liable for any failure to change or terminate this agreement until a request is received from
me in satisfactory form and reasonable time has passed for MetLife to act upon it.
If any payment is credited to my account in error, I authorize and direct my financial institution to debit my account and to
refund such overpayment to MetLife.
Name (Please Print)
Social Security Number (last 4 digits)
Signature
Date (mm/dd/yyyy)
SECTION 4 – How to Submit This Form
Please return this signed and completed form to one of the following:
Mailing Address:
Fax:
MetLife
1-866-855-2773
PO Box 14710
Lexington, KY 40512-4710
We’re here to help
If you have any questions, please call us at (800) 638-2704, Monday through Friday from 8:00 a.m. to
9:00 p.m. Eastern time.
BACH
MetLife includes: Metropolitan Life Insurance Company and MetLife Insurance Company of Connecticut.
CBF-ARS-BACH-SS (10/13) Fs
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