Electronic Payment Form (submit direct deposit)

Fill out the form below, and attach your Electronic Payment Form.

After submitting, you will receive a confirmation email.
The MDB will forward your Payment Form to Canada Life for you.
Electronic payments are the safest and quickest form of benefit payments.

Submit your Electronic Payment (direct deposit) Information Below:

Electronic Payment Form (Direct Deposit)

Name(Required)

First Middle Last

Band Number (if known)

Primary Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Upload your electronic payment form (direct deposit):(Required)

Max. file size: 256 MB.