Direct Deposit Form (Page 2 of 2) in pdf

Read and initial beside each one

of the following to show that you understand our policy & procedures

regarding your direct deposit.

_____ You are not allowed to have a partial direct deposit if you have one bank account set up.

_____ Once you cancel your direct deposit entirely, you will not be eligible for direct deposit until six months

after your cancellation date.

_____ You are responsible to notify Payroll immediately before any adjustments are made to your bank

account(s). If you do not notify Payroll of any changes or cancellations to your account(s), this will

result in your direct deposit showing up as a reject item and will delay the retrieval of your funds three

to five business days.

_____ Enrollments, changes, & cancellation requests must be submitted on our Payroll direct deposit form or

cancellation form. Payroll does not accept verbal notifications.

_____ You are allowed only two changes per calendar year.

_____ I understand that it is my responsibility to verify that payments have been credited to my account(s) and

that the Navajo Nation assumes no liability for overdrafts for any reason.

Attach a voided blank check from your checking account &/or a voided

blank savings deposit slip from your savings account here.

Please do not use staples, use scotch tape to attach.

A voided check or saving deposit slip help us verify your account(s).

Occasionally we find that employees submit incorrect numbers,

errors, &/or the handwriting is not legible.

Thank you,

Payroll dept.

I HEREBY AUTHORIZE AND DIRECT YOU TO SEND ALL MY PAYROLL CHECKS FOR

DIRECT DEPOSIT TO MY ACCOUNT(S) LISTED. This authorization will remain valid and in force until

cancelled by me or until my termination of employment with the Navajo Nation. It is my understanding that

this request will remain confidential. If I do not follow the procedures outlined, I release Payroll from any and

all liabilities.

SIGNATURE: _____________________________________________ DATE: _______________________

FOR PAYROLL USE ONLY:

DATE ENTERED: ____________________________________ DATE: ______________________________

VERIFIED BY: _______________________________________ DATE: _____________________________

Page 2 of 2

Revised 4/22/2010

Direct Deposit Form Page 2