Payroll Bank Authorization for Direct Deposit Form
Payroll Bank Authorization for Direct Deposit CATHOLIC INDEPENDENT SCHOOLS NELSON DIOCESE Section A: Personal Information
______________________________________________________________________ School (“Employer”): ____________________________________________________________________________ Last Name (as shown on Driver’s License): ___________________________________________________________ First Name: ____________________________________________________________________________________ Phone Number: ______________________________
Email: _____________________________________
Section B: Requested Action Check One Only: New Direct Deposit (first time for this school) Change Direct Deposit (previously on payroll for this school and changing bank account) Effective Date (MM/DD/YYYY): ________________________________________________ Section C: Financial Institution Information To have your entire paycheque deposited into one account, complete only “Account 1” below. If you would like your paycheque split and deposited into two accounts (e.g. a chequing and a savings account), complete both “Account 1” and “Account 2” below; you must indicate either the percentage of your paycheque or the dollar amount of your paycheque that you want deposited into Account 1. The balance will then be deposited into Account 2.
Account 1 Account 1 Type (check one):
Chequing
Savings
Account #: __________________________________
Financial Institution Name: ________________________________________________________________________ Percentage or Dollar Amount to be Deposited to this Account: ___________________________________________
Account 2 (remainder to be deposited to this account) Account 2 Type (check one):
Chequing
Savings
Account #: __________________________________
Financial Institution Name: ________________________________________________________________________
To ensure that your account number is correct, please attach a cheque marked "VOID" for an account with chequing privileges or a personalized deposit slip for a non-chequing account.
Section D: Authorization and Signature I hereby authorize the Employer to deposit my payroll payment in the financial institution designated. This authorization will be in effect until the Employer receives a written termination notice from myself and has a reasonable opportunity to act on it. ________________________________________ Employee Signature
______________________ Date
FOR OFFICE USE Entered in Payroll System If a change, emailed employee to advise change complete
______________________________________________________________________ School (“Employer”): ____________________________________________________________________________ Last Name (as shown on Driver’s License): ___________________________________________________________ First Name: ____________________________________________________________________________________ Phone Number: ______________________________
Email: _____________________________________
Section B: Requested Action Check One Only: New Direct Deposit (first time for this school) Change Direct Deposit (previously on payroll for this school and changing bank account) Effective Date (MM/DD/YYYY): ________________________________________________ Section C: Financial Institution Information To have your entire paycheque deposited into one account, complete only “Account 1” below. If you would like your paycheque split and deposited into two accounts (e.g. a chequing and a savings account), complete both “Account 1” and “Account 2” below; you must indicate either the percentage of your paycheque or the dollar amount of your paycheque that you want deposited into Account 1. The balance will then be deposited into Account 2.
Account 1 Account 1 Type (check one):
Chequing
Savings
Account #: __________________________________
Financial Institution Name: ________________________________________________________________________ Percentage or Dollar Amount to be Deposited to this Account: ___________________________________________
Account 2 (remainder to be deposited to this account) Account 2 Type (check one):
Chequing
Savings
Account #: __________________________________
Financial Institution Name: ________________________________________________________________________
To ensure that your account number is correct, please attach a cheque marked "VOID" for an account with chequing privileges or a personalized deposit slip for a non-chequing account.
Section D: Authorization and Signature I hereby authorize the Employer to deposit my payroll payment in the financial institution designated. This authorization will be in effect until the Employer receives a written termination notice from myself and has a reasonable opportunity to act on it. ________________________________________ Employee Signature
______________________ Date
FOR OFFICE USE Entered in Payroll System If a change, emailed employee to advise change complete
