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Get workers direct deposit enrolment

N 1 OR Mail to: Provider Services Dept. - TELUS Health 1000-5090 Explorer Drive Mississauga, ON L4W 4X6 Worker s Name WSIB Claim No. Address Tel. No. Fax No. City/ Province/ Postal Code Email (for confirmation of bank account changes) Contact Effective Date Banking Information: Bank Name Bank No. Address Transit No. City, Prov., P.C. Account No. Phone Fax WSIB direct-deposit-enrollment-authorization-workers-wsib-23/10/12 Please sign this form before returning to TELUS Health.

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