DEPARTMENT OF FINANCE
DEPARTMENT OF FINANCE GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES VIRGIN ISLANDS DIRECT PAYROLL DEPOSIT AUTHORIZATION Name: Social Security #: Department / Agency: Employee Number: I hereby authorize the Government of the Virgin Islands Department of Finance to directly deposit my bi-weekly net pay to the following: Checking Account Number: Routing Number: (Name of Financial Institution) Savings Account Number: Routing Number: (Name of Financial Institution) I understand that this authorization may be terminated by me upon two (2) weeks’ notice to the Department of Finance, Payroll Division. I further understand that, as a Direct Payroll Deposit Participant, I will receive a statement of earnings (i.e. Direct Deposit Advice) for all paychecks. Signature Date Note: The Department of Finance (“the department”) will be operating as your agent for the Direct Payroll Deposit, not as an agent of the depository Institution named above. The department, therefore, does not accept responsibility for any negligence on the part of said depository institution. SIGN
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DEPARTMENT OF FINANCE GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES VIRGIN ISLANDS DIRECT PAYROLL DEPOSIT AUTHORIZATION Name: Social Security #: Department / Agency: Employee Number: I hereby authorize the Government of the Virgin Islands Department of Finance to directly deposit my bi-weekly net pay to the following: Checking Account Number: Routing Number: (Name of Financial Institution) Savings Account Number: Routing Number: (Name of Financial Institution) I understand that this authorization may be terminated by me upon two (2) weeks’ notice to the Department of Finance, Payroll Division. I further understand that, as a Direct Payroll Deposit Participant, I will receive a statement of earnings (i.e. Direct Deposit Advice) for all paychecks. Signature Date Note: The Department of Finance (“the department”) will be operating as your agent for the Direct Payroll Deposit, not as an agent of the depository Institution named above. The department, therefore, does not accept responsibility for any negligence on the part of said depository institution. SIGN