Opseu Local 556 Form B - Opseu Members Personal Information Form (Mpif)

OPSEU LOCAL 556 FORM B - OPSEU MEMBERS’ PERSONAL INFORMATION FORM (MPIF) This form must be completed and submitted to Local 556 in order to receive strike duties pay. Following the protocol established by OPSEU Head Office, members who do not submit direct deposit information will not receive strike pay.

CONTACT INFORMATION (All fields required to receive strike pay)

Member’s Name: ______Address: ______

Member’s Union I.D.#: ______

Local #: 556 Postal Code: ______

Phone #: ______Non-Employer Email Address: ______

DIRECT DEPOSIT AGREEMENT

I hereby authorize Ontario Public Service Employees Union (OPSEU) Local 556, to initiate automatic deposits of my strike pay to my account at the financial institution named on the attached cheque or direct deposit form. Further, I agree not to hold OPSEU Local 556 responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.

Account Information Please attach a void cheque or a direct deposit form from your financial institution that includes the following information:

- Name of Financial Institution - Address - Bank ID - Transit Number - Account Number

I will notify OPSEU Local 556 ([email protected]) of any changes to my banking information or email address

Signature Member Signature: ______Date: ______