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Click ‘Get Form’ to open the wsib direct deposit enrollment authorization form in the editor.
Begin by entering your Legal Registered Name and WSIB/TELUS Health Provider Number in the designated fields. This information is crucial for identifying your account.
Fill in your Address, Telephone Number, Fax Number, City, Province, and Postal Code accurately to ensure proper communication.
Provide your Email address for confirmation of any bank account changes. This will help you stay informed about updates.
In the Banking Information section, enter your Bank Name, Bank Number, Transit Number, and Account Number. Ensure these details are correct to avoid any issues with deposits.
Sign the form at the bottom as the provider. If applicable, have the Clinic Owner sign as well if there are changes involving shared accounts.
Affix a pre-printed void cheque or provide a signed letter from your bank confirming account details if necessary.
Review all entered information for accuracy before submitting it back via fax or mail as instructed.
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