LM-3-V (2020-10)
LM-3-V (2020-10)
Request for Direct Deposit
Request for Direct Deposit
Detach and return the portion below.
Return to:
Information concerning the financial institution and bank account
DateSignature
Area code Telephone
11TC
Name of financial institution
Mailing address
Postal code
Branch Financial institution Account number
number number (maximum 12 digits)
I certify that the information provided in this form is accurate and complete.
I authorizeRevenu Québec to deposit my income tax refund and any other tax-related
payments in the account identified above or on the enclosed blank cheque.
Your last name
Your first name
Your social insurance number
Cancelling your registration for direct deposit
Your registration for direct deposit will remain in effect until you cancel it.
You can cancel your registration in writing or by calling 1800267-6299.
Protection of confidential information
In compliance with the
Tax Administration Act
and the
Act respecting Access to documents held
by public bodies and the Protection of personal information
, we protect your information.
Theonly Revenu Québec employees who can access your information are those who are duly
authorized and who need access as part of their work. We may use the information for the
purposes of administering the laws and socio-fiscal programs for which we are responsible.
We can also use the information to conduct studies, research and surveys, and to compilestatistics.
Subject to the restrictions provided for in the above-mentioned laws, we may communicate your
information to a government department or agency or to a third party for specific purposes
without your consent, where the information is required to administer laws or joint programs for
which the department, agency or party is responsible.
Failure to provide information can have repercussions on your file and result in the refusal of
your application. You may, under certain conditions, consult, obtain a copy of or correct your
information.
For more information, consult the guide to the income tax return (TP-1.G-V) or visit our website
at revenuquebec.ca.
Complete this form if you wish to register for direct deposit. You must have
an account at a financial institution that has an establishment in Canada.
Your income tax refund and any other tax-related payments to which you are or
may be entitled will be deposited directly into your account. You can also use this
form to change information you previously provided.
You must be registered for direct deposit to:
• claim the solidarity tax credit;
• apply for advance payments of the tax credit for home-support services
forseniors;
• apply for advance payments of the tax credit for childcare expenses;
• apply for advance payments of any tax credits respecting the work premium
(work premium, adapted work premium or supplement to the work premium
[for former recipients of social assistance]);
• apply for an advance payment of the tax credit for the treatment ofinfertility;
• apply for advance payments of the tax credit for caregivers.
How to request direct deposit
(or notify us of any changes to your information)
You can use this form to request direct deposit or to change your direct deposit
information. You can also register for direct deposit online on our website
at revenuquebec.ca.
Instructions on how to complete this form
Write only your telephone number on the detachable portion below, and then sign
and date it. On the front of a blank cheque drawn from an account you hold
at a financial institution that has an establishment in Canada (see the example below),
write the word “VOID” along with your name and social insurance number.
Send both the detachable portion of the form and the blank cheque to us in the
envelope provided.
Branch
number
Financial
institutionnumber
Account
number
NOTE
DOLLARS
10 0
001 12345012 0121231
Cheque
number
Example of a cheque
X
RÉF. : IT000
C. P. 3000, succursale Place-Desjardins
Montréal (Québec) H5B 1A4
If you are unable to supply a blank cheque, fully complete the detachable
portion below and send it to us in the return envelope. To complete the section about
the financial institution, contact your financial institution. Be sure to enter all
the digits (including initial zeroes, if any) of the branch number, the financial
institution number and your account number.
If you do not have a return envelope, send the detachable portion and blank
cheque (if applicable) to the following address: C. P. 3000, succursale
Place-Desjardins, Montréal (Québec) H5B 1A4.
IMPORTANT
You must download the form and open it with a PDF reader that can read JavaScript, such as Acrobat Reader. Some
browsers, such as Google Chrome and Microsoft Edge, come with a PDF reader that does not allow you to complete the form
correctly.
