Medi XR Employee Bank Details Form

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

Email *

Fill in this section with your personal details.

Full Name *

ID/Passport Number *

Email Address *

Fill In this Section with your Banking Details

Bank Name

Bank Branch Address

Account Type

Bank Account Number

Date *

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

E-Signature *