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Get Desjardins 02728a 2017

St name of the member Address - No., street, apartment Policy or group or contract no. City Telephone no. Province Postal code ( ) - I hereby authorize Desjardins Financial Security Life Assurance Company, hereinafter Desjardins Insurance, to deposit my benefit payment through the DIRECT DEPOSIT system into account at the financial institution indicated below: Name of financial institution: Address: Institution no.: Transit/Branch no.: Account no.: Please include a specimen cheque ma.

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