Follow the steps to complete the form accurately:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your MSP Payment Number in the designated field. This can be either your GROUP or PHYSICIAN payment number.
3. Fill in your surname or group name, ensuring it is printed clearly.
4. Provide your initials in the appropriate section.
5. Sign the authorization for direct bank payment, confirming your approval for MSP to make payments to your indicated bank account.
6. Include the date of signing and your telephone number in the designated areas.
7. Attach a blank sample cheque from your financial institution, ensuring it is fully micro-encoded with the branch, institution, and account numbers.
8. Enter the branch number, ensuring it consists of 5 digits including any zeros.
9. Fill in the institution number, which should have 3 digits.
10. Provide your account number in the designated field.
11. Fill in the name of your institution or bank, along with the branch name, street address, city, and postal code.
12. Include your province and telephone number.
13. Once all fields are completed, you may save changes, download, print, or share the form as needed.

Complete your application online today for hassle-free processing!