FORM MUST BE COMPLETED ELECTRONICALLY
Protected when completed
Res-1617 (2013-12)1 of 3
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-
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.
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
Other government : Foreign and domestic government, including provinces, territories and other level of regional and municipal government.
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.
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.
Please select the “Other” box, for any other change (i.e. email address, postal address, etc.).