Guideline on Completing the Recipient Electronic Payment Registration Form

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Recipient information

The following information is required to process the registration form :
Individual recipient : full name and remittance address.
Organizational recipient : legal name of the company and remittance address (as shown on invoice).

Banking information

Image of Void Check

  1. Cheque number - not required
  2. Institution number - 3 digits
  3. Branch number - 5 digits
  4. Account number - as shown on your cheque

Consent

This section must be completed, signed and dated by the appropriate recipient in order for the request to be authorized or electronic payments to be modified.

Sending the request to the Department of Justice

Send the duly completed form to MDV_DPF@justice.gc.ca or by mail to:

For Goods and Services Suppliers

Master Data Vendor Officer
Accounting Operations
Department of Justice Canada
284 Wellington Street, EMB-1347
Ottawa, Ontario
K1A 0H8

For Grants and Contributions

Manager, Grants and Contributions Financial Services
Department of Justice Canada
284 Wellington Street, EMB-6248
Ottawa, Ontario
K1A 0H8

Privacy Notice

Your personal information is requested and compiled by the Department of Justice Canada for the purpose of issuing electronic payments. This information will be protected under the provisions of the Privacy Act.

IMPORTANT : Must be a Canadian recipient holding a bank account in Canadian dollars.

TYPE OF REQUEST
RECIPIENT INFORMATION
BANKING INFORMATION

Please attach a void cheque. If you do not attach a void cheque, complete the fields below with your banking information.

Financial Institution Number:

Branch Number (transit)

Account Number

PAYMENT CONTACT
PRIVACY CONSENT

Authorization: I, as the organization/recipient entitled to receive payments, authorize the Receiver General for Canada to deposit the payments electronically into the account specified above until further notice. I acknowledge that all the banking information provided will be entered in the Departmental Financial System. I have read and understand this form.

FOR DEPARTMENT OF JUSTICE CANADA ONLY

PROCESSED BY


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VERIFIED BY

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SECTION 33 APPROVAL

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JUS 778e-4 (2016/11)

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