Form 20150915 - Direct Deposit Application - Government Of Nova Scotia printable pdf download

Maintenance Enforcement Program (MEP)

Direct Deposit Application

Through direct deposit any maintenance payments received will automatically be deposited into your bank account.

You must provide only one bank account number because we cannot deposit funds into more than one account.

To ensure that your account number is correct, either enclose a personalized cheque marked ‘void ’ or your bank can assist you in

completing the banking information below and stamping the form with their veriﬁcation.

Please ﬁll out, sign and return this form to:

Nova Scotia Maintenance Enforcement Program

Central Enrollment Unit

P. O. Box 803, Halifax, NS B3J 2V2

or fax to:

902-428-2166

You can confirm that a deposit has been made by calling the InfoLine at 902-424-0050 (Metro), Toll Free at 1-800-357-9248 or

through the Client Access Website at

NOTE:

If you have more than one MEP case, you will be on direct deposit for all cases.

DIRECT DEPOSIT AUTHORIZATION

Please complete in full

PERSONAL INFORMATION

BANKING INFORMATION

MEP Case # (for all cases) __________________________

Institution # _____________________________________

Personal Identiﬁcation # (PIN) ________________________

Transit # _______________________________________

Name: _________________________________________

Bank Account # __________________________________

Address: _______________________________________

Name of Financial Institution: ________________________

______________________________________________

City: __________________________________________

Address: _______________________________________

Province: _______________________________________

______________________________________________

Postal Code: ____________________________________

City, Province: ___________________________________

Phone: ____________________________________

Postal Code: ____________________________________

I hereby authorize the Maintenance Enforcement Program to deposit any payments it receives on my behalf into the MEP Trust Account

for the purpose of sending the money to me through direct deposit:

Signature: _______________________________ _________

Date: ___________________________________________

Attach a void cheque or have your ﬁnancial institution

FINANCIAL INSTITUTION STAMP

verify the information above and sign/stamp here:

OFFICE USE ONLY:

ENTERED BY: __________________________ DATE: ______________

VERIFIED BY: __________________________ DATE: ______________

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Form 20150915

Form 20150915 - Direct Deposit Application - Government Of Nova Scotia

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