Canadian Direct Deposit Enrollment Form - Completion Instructions

PDF format (.pdf 588kb)

Introduction

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

Completion Instructions

The Canadian Deposit Enrollment form is divided into three parts. They are:

• Part A - Identification Information,
• Part B - Program identification to which the individual wants to enroll, blank cheque information, date and signature; and
• Part C - Identification of the Financial Institution, account number and name(s) of the account holder(s) to which the payment is to be directed.

Section 1 - Pensioner Identification Information:

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

Step 1:

Enter: Your Last Name and First Name and initials in the boxes provided, one letter per box. Please use capital letters.

Step 2:

Enter: Your address information including the name of the city, province and postal code.

Step 3:

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 - Identification Information.

Part B - Program Identification:

Part B provides a mechanism for you to specify the payments you want deposited directly into your Canadian account. To enroll, check the appropriate box and include one of the following in the space provided: your social insurance number, file number, pension number or your contract number.

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

Step 1:

Enter: A check mark () beside the appropriate program(s).

Step 2:

Enter: Your social insurance number, file number, pension number or a contract number recognized by the issuing department.

Step 3:

Attach a blank cheque for your bank account with "VOID" written on it. If you don't have a chequing account, please see Part C.

Step 4: Signature

You, 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.

You have now completed Part B - 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 branch number, institution number, account number and the name(s) of account holder(s) to which the electronic payment is to be directed.

Step 1:

Enter: The branch number and the institution number. One number per box please.

Step 2:

Enter: Your bank account number one number/character per box.

Step 3:

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

Step 4: Signature

Enter: Your financial institution should stamp the form.

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 may 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.