Fill - Free fillable form is collected under the authority of the (Camosun College) PDF form

DIRECT DEPOSIT APPLICATION

General and Service Provider Suppliers

See instructions on Page 2 before

completing.

Freedom of Information and Protection of Privacy Act (FOIPPA) – The personal information requested on this

form is collected under the authority of the Financial Administration Act in compliance with the FOIPPA and will

be used to process your Direct Deposit Application. The nancial information contained below is protected under

the provisions of the FOIPPA and will be used only for direct deposit by means of electronic funds transfer. For

information about the collection use and disclosure practices write to the Director, Banking and Client Relations,

Treasury Payments, Ministry of Finance, Provincial Treasury, PO Box 9414 Stn Prov Govt, Victoria, BC V8W 9V1.

PART 1 – SUPPLIER INFORMATION

START DIRECT DEPOSIT

CHANGE BANKING INFORMATION

CANCEL DIRECT DEPOSIT

PART 2 – BANKING INFORMATION (Canadian Financial Institutions Only)

INDIVIDUAL LAST NAME MIDDLE NAME FIRST NAME

INDIVIDUAL LAST NAME FIRST NAME

REGISTERED BUSINESS NAME/ CORPORATION NAME

SUPPLIER NUMBER

(6 or 7 digits – if known)

MIDDLE NAME

BUSINESS NUMBER

(9 digits)

MAILING ADDRESS (include street or PO box, city, province and postal code)

IS THIS A CHANGE OF ADDRESS?

EMAIL ADDRESS

(for delivery of an electronic payment remittance)

YES NO

See Page 2 for additional instructions.

TRANSIT NO. (5 digits) BANK NO. (3 digits)

BANK ACCOUNT NUMBER

ACCOUNT HOLDER NAME(S) (if different from supplier name above)

PART 3 – PROGRAM IDENTIFICATION

Check ( ) which payments you want direct deposited to the account specied above.

ALL PROVINCE OF BC PAYMENTS

ONLY PAYMENTS FROM (enter details below):

MINISTRY ISSUING THE PAYMENT FILE NUMBER PROGRAM DESCRIPTION

PART 4 – AUTHORIZATION

I/We, the undersigned are authorized to provide the above information on behalf of the corporation/individual(s) and further authorize the

Province of BC to make payment by direct deposit into the above account until written notication to change or cancel is received.

SIGNATURE

TELEPHONE NUMBER (DAYTIME)

TELEPHONE NUMBER (DAYTIME) DATE SIGNED

DATE SIGNED

FULL LEGAL NAME

YYYY / MM / DD

SIGNATURE

Financial Institution Stamp

(not required if void cheque or direct deposit form attached)

OFFICE USE ONLY

GENERAL SUPPLIER NUMBER

MINISTRY NAMESITE

TELEPHONE NUMBER

INITIALS

MINISTRY CONTACT NAME

TREASURY PAYMENT SERVICES

INFORMATION ADD DATE:

YYYY / MM / DD

INITIALS

COMMENTS:

FIN 312/WEB Rev. 2018 / 10 / 05

( )

CHECK ( ) ONE:

Page 1

BANK NAME

ADDRESS OF BANK

(include street or PO box, city, province and postal code)

MINISTRY CONTACT SIGNATURE (electronic signature accepted)

Print Form

Clear Form

INSTRUCTIONS FOR COMPLETING THE DIRECT DEPOSIT APPLICATION

General Information

Complete this form if you want to start, change or cancel direct deposit payments from the Province of BC.

Allow 6 to 8 weeks to process your application.

Part 2 – Banking Information

Direct deposit is only available for Canadian funds to Canadian nancial institutions.

Complete Part 2 of this form with your bank account information. Attach a copy of an original voided

personalized cheque, encoded deposit slip or other supporting documentation from your nancial institution

that conrms your account information. If supporting documentation is not available, your bank can verify

the information by stamping the application form.

Do not close your bank account prior to conrming that the direct deposit service information has been

updated for Province of BC payments. Closing the account prior to updating the account information may

result in the payment being delayed.

If the payment cannot be deposited to the banking information on le, a cheque will be issued and mailed

to the address on le.

Continued on Page 3.

FIN 312/WEB Rev. 2018 / 10 / 05

Page 2

1. Cheque number – not required

2. Transit (branch) number – 5 digits

3. Bank (institution) number – 3 digits

4. Bank account number – as shown on your cheque

INSTRUCTIONS FOR COMPLETING THE DIRECT DEPOSIT APPLICATION

Sending in Your Application

To avoid delays in processing it is important to send your completed application form and supporting

documentation with your next request for payment or invoice to the ministry program issuing your

payments.

Follow the instructions provided by the ministry contact or check the ministry program’s website for

information.

Alternatively, applications can be mailed to:

Ministry Mailing Address