Hlth 2832-2026

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The document is an application form for direct bank payment from the Medical Services Plan (MSP) or a request to change banking information. It requires personal data, including the MSP payment number, applicant's signature, and banking details such as branch and account numbers. A blank sample cheque must be attached for verification.

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Click ‘Get Form’ to open hlth 2832 in the editor.
Begin by entering your MSP Payment Number, ensuring you select either the GROUP or PHYSICIAN payment number as required.
In the Personal Data section, clearly print your surname or group name along with your initials.
Authorize direct bank payment by signing in the designated area and providing the date of signature.
Fill in your telephone number for contact purposes.
Attach a blank sample cheque from your financial institution, ensuring it is fully micro-encoded with branch, institution, and account numbers.
Complete the Payment Data section by accurately entering your branch number (5 digits), institution number (3 digits), and account number.
Provide the name of your institution/bank, branch name, street address, city, postal code, province, and telephone number.

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