United States Direct Deposit Enrollment Form Completion Instructions

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Introduction

A new input form has been designed to support the capture of key information from pensioners wishing to enroll in the United States direct deposit. The following is a step by step procedure developed to guide the pensioner in the proper completion of the form.

Completion Instructions

The United States Deposit Enrollment 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:

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

Step 1 and 2:

Enter your surname and given name and initials in the boxes provided. One letter per box. Please use capital letters.

Step 3:

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

Step 4:

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

Step 5:

Enter your area code and telephone number in the event that you need to be contacted 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 payments you want deposited directly into your US account. To enroll, check () the appropriate box and include one of the following in the space provided: account number (your social insurance number), contract number, file number, pension number, or personal record identifier.

The department responsible for your pension program will use this to find your account and to issue the requested electronic payment.

Step 1:

Check off the box(es) 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 which includes the "transit data" such as the bank and branch and the account number to which the electronic payment is to be directed. For a US direct deposit it is also a requirement to identify the type of account as either a chequing or savings.

To enroll in Direct Deposit, attach a voided cheque (a blank personal cheque with "void" written on it). Be sure to sign at the 'X' below in box 8.

If you do not enclose a voided cheque, fill in boxes 1, 2, 3 and 4 below. Your financial institution should confirm this information by completing boxes 5, 6 and 7.

Step 1:

Enter the Transit/ABA No. which represents the bank and branch. One letter or number per box please using capital letters where applicable.

Step 2:

Enter your bank account number one number/character per box. Please use capitals for characters (if applicable).

Step 3:

Enter the type of account by entering a check mark () in either the chequing or savings box.

Step 4:

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

Step 5:

Enter your bank, branch address and zip code.

Step 6:

Please obtain the signature of the financial institution official.

Step 7:

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

Step 8:

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

Note: The information you provide is required and collected under the authority of the Government of Canada or its agent for the purpose of enrollment in a direct deposit service. The information provided is protected under the Canadian Privacy Act and my be accessed through your program department using the Personal Information Bank number PWGSC PPU 040

The first direct deposit may take approximately three months after receipt of your completed enrollment form.