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Click ‘Get Form’ to open it in the editor.
Begin by entering your claim number and social insurance number in the designated fields. This information is crucial for processing your request.
Fill in the worker's name, including surname, first name, and initial. Ensure accuracy as this identifies the individual associated with the direct deposit change.
Provide your complete address, including street, city/town, province, and postal code. This ensures that all correspondence reaches you without delay.
Indicate the date of the accident using the YYYY/MM/DD format. This helps link your request to specific events related to your claim.
Complete any additional sections regarding wage loss or appointment details as required. Be thorough to avoid delays in processing.
Review all entered information for accuracy before submitting. Use our platform’s features to sign and save your document securely.

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