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Treaty Annuity Payment Request

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Privacy Act Statement

The information you provide in this document is collected under the authority of the Indian Act for the purpose of administration for the payment of treaty annuities and with your consent, will be used by Aboriginal Affairs and Northern Development Canada employees who need to kno w the information in order to respond to your request. We do not share the personal information with other government departments. The personal information will be kept for a period of 30 years. Individuals have the right to the protection of and access to their personal information under the Privacy Act. The information collected is described under theTreasury Board Personal Information Bank INA PPU 009 which is detailed at  Info Source  . If you have questions regarding access to personal information, or of AANDC's Access to Information and Privacy Commissioner, please consult the Treasury Board of Canada Secretariat   .

 
Please check the region where your First Nation is located and mail request to the corresponding address


  • ALBERTA
    Claims and Indian Govt.
    630-9700 Jasper Avenue
    Edmonton AB T5J 4G2
    Tel: (780) 495-2773

  • BRITISH COLUMBIA
    LTS - Area North
    600 - 1138 Melville Street
    Vancouver BC V6E 4S3
    Tel: (604) 666-3931

  • MANITOBA
    Lands and Trust Services
    #200 - 365 Hargrave Street
    Winnipeg MB R3B 3A3
    Tel: (204) 983-2461

  •  NWT
    Registration, Revenues
    and Band Governance
    P.O. Box 2760
    Yellowknife NT X1A 2R1
    Tel: (867) 669-2622

  • ONTARIO-NORTH
    AANDC - Anemki Business Centre
    100 Anemki Place, Suite 101,
    Fort William First Nation, ON P7J 1A5
    Telephone: (807) 623-3534

  • ONTARIO-SUDBURY
    40 Elm Street
    Suite 290
    Sudbury ON P3C 1S8
    Telephone: (705) 522-5100

  • SASKATCHEWAN
    Registration, Revenues
    and Band Governance
    1 First Nation Way, Rm. 200
    Regina SK S4S 7K5
    Tel: (306) 780-5392
 
 
  I, the undersigned, request that any treaty annuity funds which are payable to me and/or the minor children in my care and custody whom I have listed, be sent to me at the address below.

I further understand that no mailing list is maintained for treaty annuity funds. If I cannot attend a treaty day in the future, I will make another application for these funds. By signing below I authorize consent for the collection of personal information for the administration for the payment of treaty annuities.

Family Name Given Name Date of Birth Band Name and Registry Number
       
       
       
       
       
       
 
 Mail Cheque to:

Name
____________________________


Address
____________________________


City
____________________________


Province
____________________________


Postal Code
____________________________


Telephone No. 
____________________________


E-Mail Address
____________________________


Signature
____________________________


Date (YYYY-MM-DD)
____________________________


 
  • Please include a photocopy of the Certificate of Indian Status (both sides) of yourself and the minor children in your care and/or custody for whom the treaty annuity funds are requested.

  • If you do not have a photocopy of a Certificate of Indian Status, a photocopy of one piece of identification (with your signature) must be substituted. If one or more of your children do not have a Certificate of Indian Status, other identification for these children must be substituted.

INTER 83-088E 2013-02-20 (A)

Date Modified:2013-03-19

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