International Direct Deposit – Québec Pension Plan

0100023
LA
International Direct Deposit – Québec Pension Plan
Section AIdentification (must be completed by the beneficiary)
SIN or Client number
under which your pension is paid
year
month
day
Date of birth
Family name
Given name
Address
Telephone
Your mother’s family name
at birth (last name only)
I hereby authorize Retraite Québec to have my pension deposited in my account at the financial institution indicated in Section B. The deposit will
be made in the currency offered by Retraite Québec for my country of residence* through an authorized financial institution and in accordance
with the terms agreed to by Retraite Québec. I further authorize Retraite Québec to provide the necessary information to the authorized financial
institution. I acknowledge that this agreement is subject to the laws of Québec and will fall under the exclusive jurisdiction of Québec courts.
*If the currency of your country of residence is available on global currency markets, we will offer direct deposit in local currency. If not, we will determine which
currency can be used in your country to make the direct deposit (U.S. or Canadian dollars).
year
Signature of the beneficiary
Section B
month
day
Date
Renseignements pour le dépôt direct international / International direct deposit information
À faire remplir obligatoirement par l’établissement financier / Must be completed by the financial institution
Nom de l’établissement financier / Name of the financial institution
Sceau de
l’établissement
financier / Financial
institution stamp
Adresse / Address
Code BIC (Swift) / BIC code (Swift)
Code ABA / ABA code
Code IFSC / IFSC code
Numéro IBAN / IBAN number
Numéro de compte / Account number
Numéro CLABE / CLABE number
Numéro de la banque et de la succursale (numéro d’acheminement) / Bank and branch code (routing number)
Type de compte (É.-U. seulement) / Type of account (U.S.A. only)
Chèques / Chequing
Épargne / Savings
IMPORTANT : Veuillez joindre un relevé d’identité bancaire (RIB). / Enclose official proof of your banking information.
Nous certifions que la personne dont le nom figure à la section A est titulaire ou cotitulaire du compte indiqué à la section B.
We certify that the person whose name appears in section A is the holder or joint holder of the account referred to in section B.
Nom de la personne autorisée par l’établissement financier / Name of the person authorized by the financial institution
Téléphone / Telephone
Signature de la personne autorisée
Signature of the authorized person
Retraite Québec
Date
Date
année
year
mois
month
jour
day
RRQ-039A (2016-06)
To sign up for or make a change in direct deposit
Retraite Québec offers you the possibility of receiving your pension by direct deposit in your bank account at the institution of your
choice. Direct deposit is advantageous because the payment is made on the day the pension is payable.
To sign up for or make a change in direct deposit, you must:
Fill in Section A of the form. In order to receive your direct deposit payment outside Canada, you must provide a complete
municipal address. A post office box number alone is not sufficient;
Have Section B filled in by an authorized person at your financial institution;
Enclose:
–
official proof of your banking information;
OR
–any other document from your financial institution on which the information provided in section B of the form is indicated
(bank number, account number or branch number).
OR
–a blank cheque with “VOID” written accross it, if the bank cannot provide official proof;
Return the documents to us at the address shown below:
Retraite Québec
Case postale 5200
Québec (Québec) G1K 7S9
CANADA
Rest assured that the information you provide will be kept confidential.
Note :If you are making a change of account, you must wait until you have received the first payment in your new
account before closing the old one.
Direct deposit of Québec Pension Plan pensions is available in the following countries and territories
Algeria
Antigua and Barbuda
Argentina
Australia
Austria
Azores
Bahamas
Barbados
Belgium
Bosnia and
Herzegovina
Botswana
Brazil
Cambodia
Cameroon
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
Finland
France
French Guiana
French Polynesia
Germany
Greece
Guadeloupe
Guam
Haiti
Hong Kong
Hungary
India
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Lebanon
Luxembourg
Madagascar
Martinique
Mauritius
Mexico
Monaco
Morocco
Netherlands
New Zealand
Norway
Panama
Peru
Poland
Portugal
Réunion
Romania
Russia
Saint Pierre
and Miquelon
Seychelles
Slovenia
South Africa
South Korea
Spain
Suriname
Sweden
Switzerland
Taiwan
Thailand
The Philippines
Trinidad and Tobago
Tunisia
Turkey
Ukraine
United Kingdom
United States
US Virgin Islands
Venezuela
If you believe that direct deposit is available in your country or territory, but that it is not indicated on the above list, please
contact us by telephone at 1 418 643‑5185 so that we can look into the possibility of paying your benefits by direct deposit.