Form PW-00030-03 "Other Post Employment Benefits (Opeb) Trust Contact Information Form" - Minnesota

Form PW-00030-03 Printable Pdf
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What Is Form PW-00030-03?

This is a legal form that was released by the Minnesota Public Employees Retirement Association - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2013;
  • The latest edition provided by the Minnesota Public Employees Retirement Association;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PW-00030-03 by clicking the link below or browse more documents and templates provided by the Minnesota Public Employees Retirement Association.

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Download Form PW-00030-03 "Other Post Employment Benefits (Opeb) Trust Contact Information Form" - Minnesota

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OTHER POST EMPLOYMENT BENEFITS (OPEB) TRUST
CONTACT INFORMATION FORM
MINNESOTA PERA
Employer Information
(please print or type)
Name of Employer
Employer Unit ID Number(s)
Address
City
Zip Code
Authorized Signer #1 for Withdrawals or Transfers
Title
Authorized Signer #2 for Withdrawals or Transfers
Title
Contact in Case of Payment Problems
Phone
E-mail Address
Fax
Bank Information
Basic bank information is needed for identification purposes when several payments are wired to our account on the same day.
Bank Name
Bank Routing and Transit Number (requires 9 digits)
Account Number
Trade Confirmation Email List
List up to three people who should receive confirmations via e-mail each time a trade occurs.
Name
E-mail Address
Name
E-mail Address
Name
E-mail Address
Return this copy to: PERA--
Finance Division, 60 Empire Drive, Suite 200, St. Paul, Minnesota 55103-2088
OTHER POST EMPLOYMENT BENEFITS (OPEB) TRUST
CONTACT INFORMATION FORM
MINNESOTA PERA
Employer Information
(please print or type)
Name of Employer
Employer Unit ID Number(s)
Address
City
Zip Code
Authorized Signer #1 for Withdrawals or Transfers
Title
Authorized Signer #2 for Withdrawals or Transfers
Title
Contact in Case of Payment Problems
Phone
E-mail Address
Fax
Bank Information
Basic bank information is needed for identification purposes when several payments are wired to our account on the same day.
Bank Name
Bank Routing and Transit Number (requires 9 digits)
Account Number
Trade Confirmation Email List
List up to three people who should receive confirmations via e-mail each time a trade occurs.
Name
E-mail Address
Name
E-mail Address
Name
E-mail Address
Return this copy to: PERA--
Finance Division, 60 Empire Drive, Suite 200, St. Paul, Minnesota 55103-2088
PW-00030-03 (04/13)
Contact Form Instructions
This contact form is needed from those entities that wish to set up an OPEB Trust as authorized in Minnesota
statutes 471.6175. If you have questions, please contact David Andrews at 651-201-2648 or via e-mail at
PERA.Accounting@mnpera.org.
Name of Employer:
The name of your county, city, township, school district, or entity.
Employer Unit ID Number:
This is your 6-digit employer ID as assigned by PERA when you joined
PERA and is found on your Salary Deduction Report.
Address:
Address used to receive paper reports.
Authorized Signers:
Include the name and title of the persons who are authorized to sign a form
when the employer wants to withdrawal or transfer assets. When a
withdrawal is requested, PERA and SBI will require two notarized
signatures as a precaution against fraud.
Contact in Case of Problems:
If we have problems processing a payment, this is the name and contact
information for the person we should contact in your agency.
Bank Name:
The name of the financial institution payments will be wired from.
Routing and Transit Number:
The 9-digit routing transit number of your financial institution.
Bank Account Number:
Your checking or savings account to be used for payment remittances.
The account number should not exceed 17 digits.
Confirmation E-mail Contacts:
Every time a trade is processed, a confirmation will be emailed to the
person(s) on this list. Up to three contacts may be entered.
Minnesota Public Employees Retirement Association Minnesota Legal Forms Legal United States Legal Forms

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