50 Ill. Adm. Code 4415.ILLUSTRATION A
A Designation for Fund Transfer for State Pension Fund for Payment of Annual Compliance Fee
Section 4415
Section 4415.ILLUSTRATION A
Designation for Fund Transfer for State Pension Fund for Payment of Annual
Compliance Fee
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:
Signed:
Dated: