Last Revised December 2016
UNIVERSITY OF TORONTO MISSISSAUGA
PAYROLL BANK AUTHORIZATION FORM for DIRECT DEPOSIT
1. T
o ensure accuracy of your account number, please enclose a cheque marked “VOID” or
a
per
sonalized deposit slip.
2. Please be sure to include all “0” and “—” when recording your account number.
3. Effective Date: Indicate when the deposit is to be effective (this is subject to Payroll deadlines)
4. Return the completed form to : Human Resources, Academic Annex, Room 112 AX 112
First Name Last Name Personnel Number
Requested Action (check one only)
Ne
w Direct Deposit (first time set-up) Change Direct Deposit
Effective Date (DD/MM/YYYY) : _________________________________________
Bank or Financial Institution Information
Name of Bank or
Financial Institution #:
Bank Transit #:
Bank Account #:
Bank Address:
(Canadian Branches only)
City: Postal Code:
I her
eby authorize the University of Toronto to deposit my payroll payment in the bank or financial
institution designated and I hereby authorize the bank or financial institution designated to release my
bank account number to the University of Toronto Payroll Department.
Signature Date
click to sign
signature
click to edit
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