Start

MEDIXR Employee Bank Details Form

Start

MEDIXR Employee Bank Details Form

Please complete the form below to authorize direct deposit of your salary into your bank account.

Email *

Section 1: Personal Information

Fill in this section with your personal details.

Full Name *

ID/Passport Number *

Email Address *

Section 2: Bank Information

Fill In this Section with your Banking Details

Bank Name
*

Bank Branch Address

Account Type

Bank Account Number
*

Section 3: Authorization

Date *

I authorize the company to deposit my salary into the bank account provided above
*

Yes

E-Signature *

Clear

MEDIXR Employee Bank Details Form

Click Submit to finish.