Res-1627 (2012-10)
FORM MUST BE COMPLETED ELECTRONICALLY
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Guidelines
Res-1617 (2013-12)1 of 3
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1 - TYPE OF REQUEST
Recipients can now receive payments from the Department by electronic payment. To sign up for electronic payments print and complete the
Recipient Registration and Electronic Payment Request form.
There are two electronic payment modes available:
1. Direct Deposit (DD) - Once payments are deposited, the department will send the following information by e-mail: amountof payment,
date of payment, invoice number, the department reference number, and brief description of the payment.This e-mail notification will
act in lieu of a cheque stub.
2. Electronic Data Interchange (EDI) - To enrol in EDI you must contact your financial institution to ensure that the account is EDI-
capable.
Complete this section by filling out one of the two request types described below:
Identify for which department you are completing this form.
AAFC = Agriculture and Agri-Food Canada CPMA = Canadian Pari-Mutuel Agency CFIA = Canadian Food Inspection Agency
CDC = Canadian Dairy Commission NRCAN = Natural Resources Canada NPA = Northern Pipeline Agency Canada
2 - RECIPIENT INFORMATION AND AUTHORIZATION
Please enter your name, address and telephone number AS WELL AS AN E-MAIL ADDRESS so that the department can send an e-mail notice
to confirm issuance of payment (for direct deposit only). Also, you must sign the form in this section in order to authorize your request.
INTRODUCTION
If you wish to make any changes to your bank account (financial institution, branch,account number, etc.) used for payments you must
complete a new Recipient Registration and Electronic Payment Request form. If you have a payment due, DO NOT CLOSE your current bank
account until you have received your payment.
Changes to bank account used
There are three sections of the Recipient Registration and Electronic Payment Request form that must be completed by the recipient.
COMPLETING THE FORM
If the recipient is an individual
Please enter the name and address of your organization and make sure to complete the ''Name of Payment Contact'' field with the name of the
contact person from your organization. The Name of Account Holder is the actual name on the bank account, and not the name of the
company. Please also include the contact person's telephone number AND E-MAIL ADDRESS so that the department can send an e-mail
notice to confirm issuance of payment (for direct deposit only). Also, authorized representative(s) must include their name, position, telephone
number and signature, in order to authorize the request.
This section allows for up to two people to sign the form, in cases where the recipient requires two signatures for authorization to receive or
modify electronic payments.
If the recipient is an organization
Provide your tax number (Business number (BN) or Goods and Services tax/Harmonized sales tax number (GST/HST) or Social Insurance
Number (SIN)) used for tax reporting purposes with Canada Revenue Agency (CRA).
Tax reporting information
Select the option that represents your status. The following terms are defined as:
Individual : Citizens, individuals and sole proprietors.
Corporation / Partnership: Corporations, Crown corporations, partnerships, associations, trusts and estates, including Canadian and foreign
entities.
Other government : Foreign and domestic government, including provinces, territories and other level of regional and municipal government.
Industry field
Indicate the email address of the person with whom you are dealing with in the department.
Department contact e-mail
If you choose to sign up for electronic payments with the department, please check the ''New request'' box and
indicate which mode of payment you wish to use: DD or EDI.
New request
Change
If you are already registered for electronic payments with the department and you wish to modify your banking
information or mode of electronic payment, please select the "Change" box and mark all other boxes that apply to
your change request.
Other
Please select the “Other” box, for any other change (i.e. email address, postal address, etc.).
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FORM MUST BE COMPLETED ELECTRONICALLY
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Guidelines
3 - BANKING INFORMATION
The void cheque must be for the account you wish to use for electronic payments. A sample of a void cheque is provided
below identifying where the transit, financial institution and account numbers are located.
Complete fields 1, 2, 3, 4 of the section 3 of the form. If you do not provide a void cheque, a financial institution
representative must validate the banking information by completing fields 5, 6 and 7 of the form. The representative must
provide the name, address and telephone number of the financial institution, bank stamp and sign the form.
4 - TRANSMITTING THE REQUEST
WHEN COMPLETED, PLEASE SEND:
BY EMAIL TO :
vendorrequest@agr.gc.ca
OR BY FAX TO:
Vendor section: 613-773-0999
If you attach a void cheque
If you do not attach a void cheque
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FORM MUST BE COMPLETED ELECTRONICALLY
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Recipient Registration and Electronic Payment Request
1 - TYPE OF REQUEST
Department
AAFC CPMA CFIA CDC NRCANNPA
Is this a new OR change request?
Electronic Data Interchange (EDI)
Direct Deposit (DD)
Other
to banking information (provide a new blank cheque)
From DD to EDI
From EDI to DD
If other, please enter details here:
Change Request:New Request:
Select the option that represents your status
Aboriginal Preferred Language
I, as an authorized representative of the above mentioned organization or as an individual entitled to receive payment from the Government of Canada,
authorize the Receiver General for Canada to deposit the payment directly into the account below and to receive payment advices electronically until
further notice.
Signature
Signature
Name(s) and Title(s) of Authorized Representative(s) and Signature(s), for organizations only (please print)
Date
Tax reporting information
Individual Corporation / Partnership Other Government
Business Number (BN) GST/HST
Number
Yes No English French
Date
Telephone number Extension
2 - RECIPIENT INFORMATION AND AUTHORIZATION
Recipient Name: Individual (Family name, First name) or Organization
Address Name of Payment Contact (please print)
City Telephone number Fax number
Province / State Postal code / ZIP
Country
E-mail for Payment Notifications (please print)
Extension
Department contact e-mail
Financial Institution Name, Address and Telephone Number
Financial Institution Number
3 - BANKING INFORMATION
Please attach a blank cheque from your bank account with "Void" written on it or complete fields 1, 2, 3 and 4 below with your banking information.
If a void cheque is not attached, your financial institution must confirm banking information by completing fields 5, 6 and 7 below.
2
Branch Number (transit)
1
Name(s) of Account Holder(s)
4
Account Number
3
Financial Institution Stamp
7
5
Signature of Financial Institution Representative
6
4 - DEPARTMENTAL USE ONLY
PROCESSED BY
Payment over $5,000Vendor Type
Current Vendor Code
Other Information
Vendor (VNDR)
Grants and Contributions (NONS)
Yes
No
Name (please print)
The personal information collected on this form is authorized by ss. 35(2) of the Financial Administration Act. Depending on the payment type, there may be additional
legislative authorities that authorize the collection. Your name, contact information, payment amount(s), banking details, departmental client identifier and Social Insurance
Number, if provided, will be disclosed to Agriculture and Agri-Food Canada by participating departments and used to create vendor profiles that facilitate electronic fund
transfers. The same information will be disclosed to Public Works and Government Services Canada (PWGSC), participating federal program(s) and your financial
institution for electronic fund transfers. Electronic fund transfer payments cannot be made without this information. The information is described in multiple Personal
Information Banks, including PWGSC’s central bank: PCU 712 Receiver General Payments. Individuals have the right to access their personal information held by
government departments and to request changes to incorrect personal information by contacting the participating departmental coordinators.
è For Electronic Data Interchange (EDI), compliancy must be confirmed by your financial institution.
è Note that Electronic Data Interchange (EDI) payments have no stub information.
IMPORTANT
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