Complete this SmartDeposit Authorization form, which allows Allstate to
electronically transfer your benefits directly to your checking or savings account.
Your money is available to you on your payment due date each month.
If you need assistance completing the information below, contact your financial
institution or bank.
SmartDeposit Authorization Form
Payee Information:
Name:____________________________________
Contract Number:_____________________
Social Security No:__________________________
Phone #:____________________________
Guardian/Power of Attorney Information (if applicable):
Name:_____________________________________
Social Security No:__________________________
Phone #:__________________________
Financial Institutions / Bank Information:
Bank Name:_______________________
Address:________________________________
Phone #: _____________________________
ABA Routing #:___________________________
(Contact your bank for this number)
Please Check One:
 Savings Account No:______________________________________________
(Attach a deposit slip showing your account number)
 Checking Account No:_____________________________________________
(Attach a check marked “VOID”. We cannot process your request without your voided check.)
AUTHORIZATION: I authorize Allstate Financial to initiate credit entries to my bank
account as shown above and necessary debit adjustments arising from the death of
payee, or error by payor which do not exceed the related credit equal to my net benefit
payments. I reserve the right to cancel this authorization by giving written notice to
Allstate Financial at its Home Office at the address below.
Signature of Payee: ______________________________
(Please sign in ink)
Please return to:
Payout Annuities
Allstate Life Insurance Company
3100 Sanders Road, M3B
Northbrook, IL 60062
SSA-002F
_________________
Date