Please complete form to apply for the 2021 Christmas Bonus
APPLICATIONS MUST BE SUBMITTED TO THE BAND BY January 14, 2022 by 12 p.m. THE BAND WILL NOT ACCEPT ANY LATE APPLICATIONS. All information provided on this form will remain private and confidential.
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Name
*
First Name
Last Name
Spouse Name (where applicable)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Band member Number (ex 025 09999 01 where applicable)
*
Spouse Band member Number (ex 025 09999 01 where applicable)
How you would like to receive your Christmas Bonus?
*
Direct Deposit
Mail - Cheque
If you chose direct deposit
Are you on Sipekne'katik Payroll or Social, and your banking information is the same
Your banking information from last year is the same
You would like to change your banking information, or you are new to direct deposit for disbursements
Upload your VOID Cheque for direct deposit information here
Browse Files
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of
Email Remittance, if you would like to receive an email remittance of your disbursement please provide your email address.
example@example.com
Signature - we understand it will not look like your signature, but please do your best
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Date of Signature
-
Month
-
Day
Year
Date
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