Outside Of Canada - Supplier, Tax And Bank Information Form
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OUTSIDE OF CANADA – SUPPLIER, TAX AND BANK INFORMATION FORM
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New
Amendment
Section 1: IDENTIFICATION
Legal Name of Entity / Individual (Surname, Given Name)
Operating Name of Entity / Individual (if different from legal name)
Building #
Street Name (PO Box not accepted)
City/Town
State/District/County
Country
Postal/ZIP Code
Email (for payment notification)
Telephone Number
Government Tax Identification Number
Remittance Address (if different than above)
State/District/County
Postal/ZIP Code
Building #
Street Name (PO Box not accepted)
City/Town
Country
Section 2: CANADIAN GOODS AND SERVICES TAX / HARMONIZED SALES TAX
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Are you a resident of Canada for Canadian Income Tax purposes?
No
Yes
(if yes, please contact IDRC for a different form)
Canadian GST/HST Number
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OR
Not Registered for Canadian GST/HST
RT
______ ______ ______ ______ ______ ______ ______ ______ ______
______ ______ ______ ______
Section 3: BANK INFORMATION
Bank Name
Account Number / CLABE (18 digits) / IBAN
Street Address (PO Box not accepted)
City/Town
Bank Sort/Branch Code
Branch Name
BIC (Swift) Code or ABA (United States)
Country
Postal/ZIP Code
State/District/County
______ ______ ______ ______ ______ ______ ______ ______ ______ _____ ______
Name of Account Holder
Other country specific instructions (ex. National ID)
Account Currency
Section 4: AUTHORIZATION
I, We, certify, as authorized officers, that the above information is correct and current
Contracting Officer
Print name:
Print Title:
Signature
Date
_________ / ________ / _________
DD
MMM
YYYY
Financial Officer
Print name and title:
Print title:
Signature
Date
_________ / ________ / _________
DD
MMM
YYYY
FOR IDRC USE ONLY
OSFI
Supplier Type
Currency of Contract
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FACFO
INDIVIDUAL
/ ENTITY
RC
E
G
I
S
Supplier Number
IDRC Administrative Contact (Name) _________________________________________________
Date __________ / __________ / __________
DD
MMM
YYYY
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