Canada Direct Deposit Enrolment Form

Protected "B" when completed.

This fillable form has been designed to make it easier for you to enrol in direct deposit. Please note that the completed form cannot be saved on your computer. Please print, sign and mail. You also have the option to print and complete the form by hand. For additional information or for assistance, you can:

• consult the Canada Direct Deposit Enrolment Form Completion Instructions
• ask your financial institution for assistance in completing the form
• contact the Receiver General at 1‑800‑593‑1666 between 8 a.m. and 8 p.m., Eastern Standard Time, Monday to Friday. People who use a telecommunication device for the deaf (TDD)/teletypewriter (TTY) should place calls with the assistance of Bell Relay Service (BRS) operators at 1‑800‑465‑7735.

Until your direct deposit information has been processed, you will continue to be paid by cheque. Please keep the appropriate federal government department or agency informed of any changes. For a change of mailing address, please contact your payment issuing department or agency by phone or mail; do not use this enrolment form. For a change in banking information, please complete a new direct deposit enrolment form and mail it to the address provided at the bottom of this form.

Please read the Privacy Notice.

Part A

Surname (maximum of 20 characters) (required)

Given name (maximum of 20 characters) (required)

Initial(s) (maximum of 2 characters)

Address (maximum of 50 characters) (required)

City, Town (maximum of 20 characters) (required)

Province (required) AB BC MB NB NL NT NS NU ON PE QC SK YT

Postal Code (no space) (required)

Telephone (999‑999‑9999)

Date of Birth (YYYY-MM-DD) (required)

Part B

Indicate the payment(s) you now receive by cheque (required):

Canada Revenue Agency

Income Tax Refund, Goods and Services Tax (GST)/Harmonized Sales Tax (HST) credit and Canada Child Tax Benefit (CCTB) and any related provincial and territorial payments, Working income tax benefit (WITB) advance payments, any other deemed overpayment of tax, and the Universal Child Care Benefit (UCCB). I understand that providing new banking information replaces any banking information on file with Canada Revenue Agency (CRA) and will stay in effect until changed by me.

Canada Revenue Agency Payment(s) Yes/No Yes No

If you have specified "Yes" for Canada Revenue Agency Payment(s), please enter your Social Insurance No.

Social Insurance No. (Canada Revenue Agency) (no dashes or spaces, 9 digits)

Service Canada

Old Age Security Yes/No Yes No Canada Pension Plan Yes/No Yes No

If you have specified "Yes" for Old Age Security or/and Canada Pension Plan, please enter your Social Insurance No.

Social Insurance No. (Service Canada) (no dashes or spaces, 9 digits)

Canadian Government Annuities Yes/No Yes No

If you have specified "Yes" for Canadian Government Annuities, please enter your Contract No.

Contract No. (no dashes or spaces, 10 digits)

Veterans Affairs Canada

Veterans Affairs Pension or Award Yes/No Yes No War Veterans Allowance Yes/No Yes No Veterans Affairs Financial Benefits Yes/No Yes No

If you have specified "Yes" for Veterans Affairs Pension or Award or/and War Veterans Allowance or/and Veterans Affairs Financial Benefits please enter your File No.

File No. (no dashes or spaces, 7 digits)

Part C

Canadian Financial Institution Only

Instead of filling in Part C, you can attach a "VOID" cheque of your Canadian bank account.

Your branch number, financial institution number and account number can be found at the bottom of your cheque.

1. Cheque No.—first 3 digits—is not required.
2. Branch No.: digits 4 to 8.
3. Institution No.: digits 9 to 11.
4. Account No.: remaining digits.

Branch No. (5 digits) (required) Institution No. (3 digits) (required) Account No. (dashes also accepted, 12 digits) (required)

Financial institution's stamp here

 

Name of account holder (1) (maximum of 29 characters) Name of account holder (2) (maximum of 29 characters) Name of account holder (3) (maximum of 29 characters)

Part D

Consent

I, the under-signed, consent to the Receiver General for Canada issuing my payments as indicated above, by direct deposit to my bank account.

I, the under-signed, have read the Privacy Notice and consent to the collection, use, and disclosure of my personal information as outlined in the notice.

To ensure prompt payment(s), I will notify the Receiver General for Canada of any changes to my banking information.

I, the under-signed confirm that all information provided above is correct.

Date (YYYY-MM-DD)

2014-03-27

Signature of Applicant

Preferred Language English Français

Mailing address

Mail the completed and signed form to the address indicated below:

Receiver General for Canada
P.O. Box 5000
Matane, Qc
G4W 4R6

Until your direct deposit information has been updated, you will continue to be paid by cheque.

Please do not use this form to provide change of address information.

Please ensure that you sign the form before mailing.

Please "clear data" once the form has been printed to ensure that your information is not visible to other users of this computer.

Privacy Notice

The personal information on this form, including your Social Insurance Number (SIN), is collected by the Receiver General for Canada pursuant to the Department of Public Works and Government Services Act, s. 11 and the Financial Administration Act, ss. 35(2). Depending on payment type, additional Acts may be applicable (for example, the Income Tax Act for SIN use to pay your income tax refunds). Your name, contact information, payment amount(s), bank account, departmental client identifier, including SIN if required, will be used and disclosed to participating federal program(s) and your financial institution for direct deposit purposes. Payments can not be made without this information, including the SIN, where applicable. The information is described in Personal Information Bank, PWGSC PPU 712 Receiver General Payments. Your personal information, including SIN, is protected and will only be used and disclosed in accordance with the Privacy Act. Individuals have the right to request access and correct their personal information, if erroneous or incomplete.