Fillable DIRECT DEPOSIT ENROLMENT FORM (Natural Resources Canada)

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DIRECT DEPOSIT ENROLMENT FORM (Natural Resources Canada)

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PWGSC-TPSGC 8001-552E (2020-02)
IMPORTANT: Complete Part C or attach a blank cheque with "VOID" written on it.
Address
DIRECT DEPOSIT ENROLMENT FORM
Public Works and Government
Services Canada
Travaux publics et Services
gouvernementaux Canada
PROTECTED "B" when completed
Surname
Given Name
Telephone No.
City/Town
Postal Code
Province
Date of Birth
(
YYYYMMDD
)
PART A - Applicant's Identification Information
PART B - Payment Information (Indicate the payment(s) to which you would like this change applied.)
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 Revenue Agency
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 C - Banking Information (Canadian financial institutions only)
Social Insurance No.
Branch No.
Financial Institution Stamp
(requiredifnovoidchequeattached)
Financial Institution No.
Account No.
Name(s) of Account Holder(s)
Initial(s)
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.
Instructions
Clear Data
Validate form
PWGSC-TPSGC 8001-552E (2020-02)
PART D - Legal Representative
Address
Surname
Given Name
City/Town
Initial(s)
Province
Telephone No.Postal Code
PART E - Consent
Date (YYYYMMDD)
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.11andtheFinancial 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.
I, the undersigned, have read the Privacy Notice and consent to the collection, use and disclosure of my personal information as
described therein.
X
Signature of Applicant or Legal Representative
IMPORTANT: Only complete Part D if you are signing on the applicant’s behalf.
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 w ill 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.
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 clie nt as though the y were the client themselves. A legal representative includes, but is not limited to, Power of
Attorney, Executor, Legal Guardian and Public Trustee.
Role
2 0 2 0 0 2 1 4
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
whichdirectdepositpaymentsaretobemade.Thesedetailscanalsobefoundonachequeassociatedwiththat
bank account. Your financial institution must stamp this section to verify that the correct banking details have been
entered i
f
no void che
ue is attached.
PWGSC-TPSGC 8001-552E (2020-02)
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, E xecutor, 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 re ad and agreed with
the consent statement on the form.
1. Cheque number - not required.
2. Branch number - 5 digits.
3. Insti tution number - 3 digits.
4. Account number - as shown on your cheque.
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DIRECT DEPOSIT ENROLMENT FORM (Natural Resources Canada)

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Completed 14 September 2020

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