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DIRECT DEPOSIT SIGN UP FORM Canada SSA Gov
NUMBER
B.I.C.
(OPTIONAL)
Name of Person Entitled to the Benefits
Telephone Number:
THIS BOX IS FOR ALLOTMENT OF PAYMENT ONLY (if applicable)
Type
PAYEE CERTIFICATION
I (beneficiary or representative payee) certify that I have read
and understand the back of this form. In signing this form, I
authorize the Social Security Administration to send this payment
to the financial institution indicated in Section 3 and deposit it in
the designated account. I understand that personal information...
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