TO WHOM IT MAY CONCERN 

To better assist you we are preparing to disburse payments electronically to our Capita Financial Services partners via CIBC FirstCaribbean Online Services.  Therefore, we are asking that you complete the necessary information below and return the form via email as soon as possible to finance@capitacaribbean.com. 

Electronic Payment Form

Telephone Numbers

TIN / TAMIS Number

Name on Bank Account

Name of Banking Institution & Branch (where account was opened)

Transit, Bank Account No & Account Type (Chequing / Savings)

Name, Telephone number & Email address

Signature

Date

MM slash DD slash YYYY

Print Name