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    Canada Eng

    Uploaded by

    paolomarabella8
    1) The document is a direct deposit enrollment form for Canadians to enroll to receive government payments by direct deposit into a bank account rather than by cheque. 2) It requests the applicant's identification information such as name, address, date of birth, social insurance number, and which government payments they want deposited directly. 3) The applicant must provide their bank account information or attach a void cheque for verification, and consent to the collection and use of their personal information for direct deposit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Canada Eng

    Uploaded by

    paolomarabella8
    58 views3 pages
    1) The document is a direct deposit enrollment form for Canadians to enroll to receive government payments by direct deposit into a bank account rather than by cheque. 2) It requests the applicant's identification information such as name, address, date of birth, social insurance number, and which government payments they want deposited directly. 3) The applicant must provide their bank account information or attach a void cheque for verification, and consent to the collection and use of their personal information for direct deposit purposes.

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    1) The document is a direct deposit enrollment form for Canadians to enroll to receive government payments by direct deposit into a bank account rather than by cheque. 2) It requests the applicant's identification information such as name, address, date of birth, social insurance number, and which government payments they want deposited directly. 3) The applicant must provide their bank account information or attach a void cheque for verification, and consent to the collection and use of their personal information for direct deposit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    58 views3 pages

    Canada Eng

    Uploaded by

    paolomarabella8
    1) The document is a direct deposit enrollment form for Canadians to enroll to receive government payments by direct deposit into a bank account rather than by cheque. 2) It requests the applicant's identification information such as name, address, date of birth, social insurance number, and which government payments they want deposited directly. 3) The applicant must provide their bank account information or attach a void cheque for verification, and consent to the collection and use of their personal information for direct deposit purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Instructions Clear Data Validate form

    Public Works and Government Travaux publics et Services PROTECTED "B" when completed
    Services Canada gouvernementaux Canada

    DIRECT DEPOSIT ENROLMENT FORM


    Please print clearly and in block letters. Do not use this form to provide change of address information. Do not enclose
    anything other than your void cheque with this form.

    PART A - Applicant's Identification Information

    Surname

    Given Name Initial(s)

    Address

    City/Town Province

    Postal Code Telephone No.

    Date of Birth Social Insurance No.


    (YYYYMMDD)

    PART B - Payment Information (Indicate the payment(s) to which you would like this change applied.)

    Canada Revenue Agency


    Income tax refund, Goods and Services Tax/Harmonized Sales Tax (GST/HST) credit, Canada Child Benefit (CCB) and any
    related provincial and territorial payments, Canada Workers Benefit (CWB) advance payments, any other deemed
    overpayment of tax, and any applicable benefit payments for previous years. I understand that providing new banking
    information replaces any banking information on file with CRA, and it will stay in effect until changed by me.

    Service Canada

    Canada Pension Plan Old Age Security Canada Pension Plan Disability

    I understand that providing new banking information replaces any banking information on file with the Service Canada program(s) I
    am selecting, and it will stay in effect until changed by me.

    PART C - Banking Information (Canadian financial institutions only)


    IMPORTANT: Complete Part C or attach a blank cheque with "VOID" written on it.

    Branch No. Financial Institution No.

    Account No.

    Name(s) of Account Holder(s)

    Financial Institution Stamp


    (required if no void cheque attached)

    PWGSC-TPSGC 8001-552E (2023-03)


    PART D - Legal Representative
    IMPORTANT: Only complete Part D if you are signing on the applicant’s behalf.
    A legal representative is an individual or organization authorized by virtue of a legal document, such as a Power of Attorney, to act
    on behalf of the client as though they were the client themselves. A legal representative includes, but is not limited to, Power of
    Attorney, Executor, Legal Guardian and Public Trustee.

    Surname

    Given Name Initial(s)

    Role

    Address

    City/Town Province

    Postal Code Telephone No.

    PART E - Consent
    Provision of the personal information, including your Social Insurance Number (SIN), is pursuant to Department of Public Works and
    Government Services Act, s. 5, s.11 and the Financial Administration Act, ss. 35(2). The Receiver General will use and disclose
    information to the federal institutions identified in Part B and to your financial institution in order to issue direct deposit payments,
    but will not disclose your SIN to your financial institution. Your personal information will be protected, used and disclosed in
    accordance with the Privacy Act, and as described in Personal Information Bank PWGSC PSU 712, Receiver General Payments. Under
    the Act, you have the right to access and correct your personal information, if erroneous or incomplete.

    If you require clarification about this privacy notice, you may contact the Public Services and Procurement Canada’s Access to
    Information and Privacy Directorate by email at TPSGC.ViePrivee-Privacy.PWGSC@tpsgc-pwgsc.gc.ca. If you are not satisfied with
    the response to your privacy concern or if you want to file a complaint about the handling of your personal information, you may
    wish to contact the Office of the Privacy Commissioner of Canada.

    I, the undersigned, have read the Privacy Notice and consent to the collection, use and disclosure of my personal information as
    described therein.

    2 0 2 3 0 3 0 1 X
    Date (YYYYMMDD) Signature of Applicant or Legal Representative

    PWGSC-TPSGC 8001-552E (2023-03)


    Form

    Mail the completed form to the following address:

    RECEIVER GENERAL FOR CANADA


    PO BOX 5000
    MATANE QC G4W 4R6

    Need help with this form? Call 1-800-593-1666 (toll-free) Monday, Tuesday, Wednesday and Saturday from
    7 a.m. to 7 p.m. or Thursday and Friday from 7 a.m. to 10 p.m., Eastern Standard Time (TDD/TTY:
    1-844-524-5286), visit www.directdeposit.gc.ca or consult with your financial institution.
    Until your direct deposit information has been updated, you will continue to be paid by cheque or direct deposit to
    the bank account currently on file.

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

    Please do not use this form to provide change of address information. To change your address information, please
    contact the department or agency that issues your payments.

    Part A - Applicant's Identification Information


    Fill in the surname (last name), given name (first name) and any middle name initials, as well as the full address,
    telephone number, date of birth and Social Insurance Number (SIN) of the applicant in the fields provided. All fields
    are mandatory.

    Part B - Payment Information


    Indicate the payment(s) the applicant currently receives by cheque and wishes to receive by direct deposit. If the
    applicant is already receiving payments by direct deposit and wants to change the banking details on file, indicate
    the payment(s) for which the change should be applied. The payment(s) indicated here will be deposited into the
    bank account indicated in Part C.

    Part C - Banking Information


    This form can only be used for direct deposit payments destined for domestic (Canadian) bank accounts that use
    standard routing information, i.e., a Branch Number, Institution Number and Account Number. For direct
    deposit payments into foreign bank accounts, please consult the Foreign Direct Deposit Enrolment Form found at
    www.directdeposit.gc.ca.

    Instead of filling in Part C, a blank cheque with the word "VOID" written across the front can be attached to this
    form - see example below. This cheque must be associated with the Canadian bank account into which the
    payments indicated in Part B are to be deposited. Do not enclose anything other than a void cheque with
    this form.

    If completing Part C of this form, account routing information can be obtained from the financial institution into
    which direct deposit payments are to be made. These details can also be found on a cheque associated with that
    bank account. Your financial institution must stamp this section to verify that the correct banking details have been
    entered if no void cheque is attached.
    f q

    1. Cheque number - not required. 3. Institution number - 3 digits.


    2. Branch number - 5 digits. 4. Account number - as shown on your cheque.

    Part D - Legal Representative


    If the applicant is signing Part E of this form on their own behalf, Part D does not need to be completed. If you are
    signing the form on the applicant's behalf, as the applicant's legal representative, indicate your name, role, address
    and telephone number. Examples of 'Role' can include Power of Attorney, Executor, Legal Guardian, Public Trustee,
    etc.

    Part E - Consent
    Date and sign the form in order for it to be processed. By signing, you confirm that you have read and agreed with
    the consent statement on the form.

    PWGSC-TPSGC 8001-552E (2023-03)

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