Navigation pointers

Request for Direct Deposit

LM-3.M-V 2012-01
E

Erase

Complete this form if you wish to register for direct deposit. You must have an account at a financial institution that has an establishment in Canada. Your income tax refund and any other tax-related payments to which you are or may be entitled will be deposited directly into your account. You can also use this form to change information you previously provided. You must be registered for direct deposit to claim the solidarity tax credit; apply for advance payments of the tax credit for home-support services for seniors; apply for advance payments of the tax credit for childcare expenses; apply for advance payments of any tax credits respecting the work premium (work premium, adapted work premium or supplement to the work premium).

How to request direct deposit (or notify us of any changes to your information)
You can use this form to request direct deposit or to change your direct deposit information. You can also register for direct deposit online on our website at www.revenuquebec.ca.

Instructions on how to complete this form

Write only your telephone number on the detachable portion below, and then sign and date it. On the front of a blank cheque drawn from an account at a financial institution that has an establishment in Canada (see the example below), write the word VOID along with your name and social insurance number. Send both the detachable portion of the form and the blank cheque to us in the envelope provided. If you are unable to supply a blank cheque, provide all the information requested on the detachable portion below and send it to us in the envelope provided. To complete the section about the financial institution, contact your financial institution. Be sure to enter all the digits (including initial zeroes, if any) of the branch number, the financial institution number and your account number. If you do not have a return envelope, send the detachable portion and blank cheque (if applicable) to the following address: C. P. 3000, succursale Place-Desjardins, Montral (Qubec) H5B 1A4.

Example of a cheque
Branch number Financial institution number

Account number

Cheque number
NOTE

100

DOLLARS

001

12345 012

012 123 1

Cancelling your registration for direct deposit

Your registration for direct deposit will remain in effect until you cancel it. You can cancel your registration in writing or by calling 1 800 267-6299. However, to be entitled to the solidarity tax credit, you must be registered for direct deposit.
Detach and return the portion below.

Request for Direct Deposit

Your name Your social insurance number Name of nancial institution Mailing address

LM -3.M -V ( 2012-01)
E

Information concerning the nancial institution and bank account

Postal code

10UQ
Validate
Return to: Branch number Financial institution number Account number (maximum 12 digits)

RF. : IT000 C. P. 3000, succursale Place-Desjardins Montral (Qubec) H5B 1A4

I certify that the information provided in this form is accurate and complete. I authorize Revenu Qubec to deposit my income tax refund and any other tax-related payments in the account identified above or on the enclosed blank cheque.

Signature

Date

Area code Telephone

Print