JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PCD Direct Deposit Request Form
Indian Registry and Membership Department - Alexis Nakota Sioux Nation
Sign in to Google
to save your progress.
Learn more
* Indicates required question
I am requesting to receive my Per Capita Distribution Entitlements through Direct Deposit
Name
*
Your answer
Treaty No.
*
Your answer
Spouse
Your answer
Dependents:
Your answer
I am:
*
On Reserve
Off Reserve
PLEASE EMAIL DIRECT DEPOSIT / BANKING INFORMATION TO
PCD@ANSN.CA
Mailing Address
*
Your answer
Phone Number
*
Your answer
Deadline for Direct Deposit is Friday December 10th, 2021 at 4:30PM
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
