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ED STATES SOCIAL SECURITY MONTHLY BENEFITS BY DIRECT DEPOSIT Complete Section 1 and "SIGN YOUR NAME" Ask your bank to complete Section 3 Mail completed form back using address in Section 2 SECTION 1 (TO BE COMPLETED BY PAYEE) Name and Complete Mailing Address: B.I.C. (OPTIONAL) SOCIAL SECURITY CLAIM NUMBER Name of Person Entitled to the Benefits Telephone Number: THIS BOX IS FOR ALLOTMENT OF PAYMENT ONLY (if applicable) Type PAYEE CERTIFICATION I (beneficiary or representative p.

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  2. Choose the Get form button to open it and begin editing.
  3. Fill out all the requested boxes (they will be marked in yellow).
  4. The Signature Wizard will help you add your e-signature right after you?ve finished imputing information.
  5. Put the relevant date.
  6. Double-check the whole form to make certain you?ve filled in all the information and no corrections are required.
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