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Benefits

ACH Bank Draft Authorization Form

Fill out and submit this form to enable automatic monthly payment of your UK Retiree Health Insurance premiums by bank draft (ACH).

04/05/2006 (revision date)
Click to view form (pdf or doc): ACH Bank Draft Authorization Form
Submission Options
Submit paper form to Benefits Office, 112 Scovell Hall
Email form back to benefits@email.uky.edu