Direct Deposit Enrolment Form

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 PCU 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.

Print clearly and in block letters. Please keep the appropriate federal government department informed of any changes to your mailing address. Should the department require clarification on the data you have provided, they will contact you.

Instructions for completing the Direct Deposit Enrolment Form

  • You can copy and paste the required form information below into a word processor, provide the appropriate information, print, sign and send by mail to the address at the bottom of this form.
  • You can also print the form, fill in the fields by hand, sign and send by mail to the address at the bottom of this form.
  • For help, consult the Form Completion Instructions. You can also ask your financial institution for help in completing the form.
  • For information, call 1-800-593-1666 between 8 a.m. and 8 p.m., Eastern Standard Time, Monday to Friday. People who use a TDD/TTY should place calls with the assistance of Bell Relay Service (BRS) operators at 1-800-465-7735.

Part A

This part provides spaces for you to identify your name, address, telephone number, and date of Birth.

  1. Surname:
  2. Given name:
    Initial(s):
  3. Address:
    City, Town:
    Province:
    Postal Code:
  4. Telephone:
  5. Date of Birth (YYYYMMDD):

Part B

  1. Indicate the payment(s) you would like to receive by direct deposit

Canada Revenue Agency

  • Income Tax Refund, GST/HST credit, WITB advance payments, and any other deemed overpayment of tax: Yes/No
  • Child Tax Benefit: Yes/No
  • Universal Child Care Benefit: Yes/No
  • Social Insurance No. (9 digits):

Service Canada

  • Old Age Security: Yes/No
  • Canada Pension Plan: Yes/No
  • Social Insurance No. (9 digits):

  • Government of Canada Annuities: Yes/No
  • Contract No. (10 digits):

Veterans Affairs Canada

  • Veterans Affairs Pension or Award: Yes/No
  • War Veterans Allowance: Yes/No
  • Veterans Affairs Financial Benefits: Yes/No
  • File No. (7 digits):

Part C

  1. If you have enclosed a "voided" cheque, do not have your financial institution complete this part.
  1. Branch No. (5 digits):
    Institution No. (3 digits):
  2. Account No. (up to 12 digits):
  3. Name(s) of account holder(s):




  1. Financial Institution Stamp Here
    Financial Institution Stamp Here

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 above 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.

  1. Date (yy-mm-dd):
  2. Signature of Applicant:
  3. Language Preference: English/Français

Mailing address

Mail the completed form to the address shown 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.

To update your banking information, please complete a new direct deposit enrolment form.

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