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
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
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
If completing Part C of this form, account routing information can be obtained from the financial institution into
bank account. Your financial institution must stamp this section to verify that the correct banking details have been
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,
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.