Electronic Deposit Authorization
If you would like to receive your Optuma payments via electronic deposit, please read, complete and sign this authorization form. Note that in some jurisdictions this is now the only method by which you can be paid by Optuma.
By signing this form, I authorize Optuma Pty Ltd to deposit funds directly into the account indicated below. I warrant that the details are correct, and I am responsible for any loss of funds associated with errors on this form.
October 16, 2019
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: Electronic Deposit Authorization
Agree & Sign