Attach your personal blank cheque (marked “void”), or a full encoded deposit Slip. Please make sure that you have your bank institution identification number on your deposit slip.

Mail the enrollment/authorization and your “VOIDED” cheque or your encoded

Deposit slip to the Key First Nation immediately.

Authorization

Name: ____________________________________________________________________

Address:___________________________________________________________________

_________________________________________________________________________

__________________________________________________________________________

Phone:_____________________________________________________________________

Bank Identification Number: ____________________________________________________

Transit Number: _____________________________________________________________

Account Number : ______________________________

I (we) hereby authorize the Key First Nation to deposit directly to my (our) account as noted on the form effective June 4, 2004 . This authorization will be in force until written notice is given to the direct deposit.

Student Signature: ____________________________________ Date: _________________________

Spouse Signature: ____________________________________ Date: _________________________