Czech Republic Form Completion Instructions

A direct deposit form has been designed to support the capture of key information from pensioner's wishing to enrol on direct deposit in Czech Republic. The following is a step by step procedure developed to guide the pensioner in the proper completion of the form.

Completion Instructions

The Czech Republic enrolment form is divided into three sections. They are:

  • Part A - Pensioner Identification Information;
  • Part B - Pension Program Identification; and
  • Part C - Identification of the Financial Institution.

Part A - Pensioner Identification Information

This image is a screen capture of Part A of the Czech Republic enrolment form

Part A provides space for you to identify your name, address and telephone number. The following is a step by step procedure.

Step 1 and 2

Enter your surname and given name and initial(s) in the boxes provided. One letter per box. Please use capital letters.

Step 3

Enter your address information including the name of the city and country.

Step 4

Confirm if the address is new by entering (checked box) in yes or no.

Step 5

Enter your area code and telephone number in the event that we may need to contact you to seek clarification on the information provided.

You have now completed Part A - Pensioner Identification Information.

Part B - Pension Program Identification

Part B provides a mechanism for you to specify the payment(s) you want deposited directly into your Czech Republic account. To enrol, check checked box the appropriate box and include one of the following in the space provided: your social insurance number, contract number, file number, pension number, or personal record identifier.

The department responsible for your pension program will use this information to match your entitlement and to issue the requested electronic payment.

This image is a screen capture of Part B of the Czech Republic enrolment form

Step 1

Check off the box(es) checked box for the payment(s) you wish to receive by direct deposit.

Step 2

Enter the number associated to each type of payment you wish to receive.

You have now completed Part B - Pension Program Identification.

Part C - Identification of the Financial Institution

Part C provides specific fields for you to capture your direct deposit account information. The IBAN has a fixed format for each country. Please contact your local financial institution for a better understanding of your IBAN.

This image is a screen capture of Part C of the Czech Republic enrolment form

Step 1

Enter the IBAN number provided by the financial institution which represents a complete identifier, that includes original bank code and account number, plus additional characters to identify the country and special check digits.

AND

Along with the IBAN number, please also include the BIC SWIFT number which is the code that identifies the specific electronic address of the financial institution.

Step 2

Enter the name(s) of the account holder(s).

Step 3

Enter your financial institution name, address and postcode.

Step 4

Please obtain the signature of the financial institution official.

Step 5

Enter your bank area code and telephone number, in the event that they need to be contacted for clarification on the information provided.

Step 6

The beneficiary must sign and date the bottom of the enrolment form. If the individual completing this form is a guardian or a relative acting on behalf of the beneficiary, this enrolment information will not be considered valid without the beneficiary's signature.

For additional information, call 00-800-3671-8290 between the hours of 8 a.m. and 8 p.m., Eastern time.