Document 6492427

Human Resources
Development Canada
Développement des
ressources humaines Canada
Income Security Programs
Programmes de la sécurité du revenu
Ce document est également disponible en français sous le titre « Feuillet
d'information - Comment présenter une demande de pension de la Sécurité de la
vieillesse, d'Allocation ou d'Allocation au survivant ».
– Important –
Retain this Information Sheet for your records
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Information Sheet
How to Apply for the Old Age Security Pension,
Allowance and Allowance for the Survivor
Are you applying for the Old Age Security
pension?
This information sheet, which helps you
complete the application form, is part of a kit
which includes:
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an application form you can use to apply for the
Old Age Security pension, Allowance or
Allowance for the Survivor.
Getting started
Are you applying for the Allowance or the
Allowance for the Survivor?
Please read this information sheet before you
complete your application. The explanations match
the box numbers on the application form.
Please use a pen to complete your application and be
sure to print as clearly as possible.
Fill out as much of the application form as you can.
If you need help, have a list of your questions ready
and call us at the telephone numbers we have listed
in the section called "How to contact us". Our lines
are busiest at the beginning and end of each month,
so if your business can wait, it's best to call at other
times. Please have your Social Insurance Number
ready.
For general information on Income Security
Programs, you can also visit our Internet site at:
http://www.hrdc-drhc.gc.ca/isp (English)
http://www.hrdc-drhc.gc.ca/psr (French)
If you are applying for the Allowance or the
Allowance for the Survivor, you can send your
application up to 12 months before your 60th
birthday. If you are already 60 or older, send your
application as soon as possible so you won’t lose
any payments.
DOCUMENT CHECK LIST
Documents You Need
to Provide
You can also make an appointment with one of our
service delivery agents. To do so, call us at the
telephone numbers we have listed in the section
called "How to contact us".
HOW TO CONTACT US
In Canada or the United States, call:
1 800 277-9914 (for service in English)
1 800 277-9915 (for service in French)
1 800 255-4786 TTY/Teletypewriter Users Only
If you are applying for the Old Age Security
pension, you can send your application up to 12
months before your 65th birthday. If you are
already 65 or older, send your application as soon
as possible so you won’t lose any payments.
Birth or Baptismal
certificate
Proof of entry into,
departure from
Canada (for all
periods longer than
6 months)
Old Age
Allowance
Security
Allowance
for the
Survivor
ü
ü
ü
ü
ü
ü
Proof of Canadian
citizenship or legal
residence status if
you were not born in
Canada
ü
ü
ü
Indicate your Social
Insurance Number on
all documents before
sending them to us
(except originals)
ü
ü
ü
ü
ü
Marriage certificate
Death certificate
ü
If you have already provided these documents to the
Old Age Security Program or Canada Pension Plan,
you do not have to provide them again.
See the section titled "Send certified photocopies
instead of originals".
ISP-3000-A-00E
Internet Version
Page 1 of 12
This Information Sheet contains general information
concerning the Old Age Security pension, the
Allowance and the Allowance for the Survivor. The
information reflects the Old Age Security legislation. If
there are any differences between what is in the
Information Sheet and the Old Age Security Act, the
Act is always right.
Basic eligibility factors for the Allowance
To qualify for the monthly Allowance you must:
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Basic eligibility factors for the Old Age
Security pension
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To qualify for the monthly Old Age Security pension
you must:
l be 65 years of age or older;
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l meet the residence requirements;
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l complete and sign the application.
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be between the ages of 60 and 64;
be the spouse or common-law partner of a person
who is eligible to receive the Guaranteed Income
Supplement;
have no income or a limited amount of income;
be a Canadian citizen or a legal immigrant;
meet the residence requirements;
submit the necessary documents; and
complete and sign the application.
The amount of the Allowance is based on income.
Your income and your spouse's or common-law
partner's income will be combined and used to
calculate the amount of benefit payable.
To qualify for a "Full" Old Age Security
pension
Basic eligibility factors for the Allowance for
You qualify for a full pension if you have resided in
Canada for periods totaling at least 40 years after
age 18. You can also qualify for a full pension if on
July 1, 1977:
To qualify for the monthly Allowance for the
Survivor you must:
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you were at least 25 years of age; and
you were resident in Canada or had a valid
Immigration Visa to Canada; or
you had some prior residence in Canada after age
18; and
you resided in Canada for the 10 years
immediately before your application is approved;
or
you resided in Canada for the year immediately
before your application is approved and you had
been in Canada for periods that equal 3 times the
length of any absences during the 10 years before
your application is approved.
To qualify for a "Partial" Old Age Security
pension
the Survivor
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be between the ages of 60 and 64;
be widowed;
have no income or a limited amount of income;
be a Canadian citizen or a legal immigrant;
meet the residence requirements;
submit the necessary documents; and
complete and sign the application.
You can only receive the Allowance for the
Survivor after the death of your most recent
spouse or common-law partner.
The amount of the Allowance for the Survivor is
based on income.
To qualify for an Allowance or an
Allowance for the Survivor
To qualify for an Allowance or an Allowance for the
Survivor you must be at least 60 years of age and meet
the residence requirements. The minimum period of
residence necessary to qualify for an Allowance or an
Allowance for the Survivor is 10 years of residence in
Canada after age 18. "Residing in Canada" means that
you make your home and usually live in Canada. To
confirm your residence history, you must complete
question 16.
If you do not qualify for a full Old Age Security
pension, you may qualify for a partial pension. A
partial pension is earned at the rate of 1/40th of the
full pension for each complete year of residence in
Canada after age 18. The minimum period of
residence necessary to qualify for a partial
pension is:
l 10 years of residence in Canada after the age of
18, if we are paying you the pension while you
reside in Canada; and
l 20 years of residence in Canada after the age of
18, if we are paying you the pension while you
reside outside of Canada.
ISP-3000-A-00E
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Internet Version
VERY IMPORTANT
If you do not meet the minimum residence
requirements to qualify for an Old Age Security
pension, an Allowance or an Allowance for the
Survivor, you may qualify for a benefit under an
international social security agreement. Refer to the
section titled "Have you lived or worked in another
country?" in this information sheet.
Send certified photocopies
instead of original documents
With your application, you usually have to send us
certain documents, such as birth certificates or
marriage certificates. If you have to send us
documents, try to send us certified photocopies
instead of the original documents. If you do decide to
send your original documents, you may want to send
them by registered mail. We will return all the
original documents you send us.
Keep in mind, however, that we can only accept a
photocopy if it is readable and if you have
someone certify it as a true copy of the original. If
you can bring your original documents into any
Human Resources Development Canada (HRDC)
office, our staff will photocopy the documents and
certify them for free. If you cannot visit an HRDC
office, you can ask one of the following people to
certify your photocopy:
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an Accountant
a Chiropractor
a Commissioner of Oaths
a Dentist
a Doctor
an Employee of a Federal or Provincial Department
or one of its agencies
a Funeral Director
a Justice of the Peace
a Lawyer
a Magistrate
a Manager of a Financial Institution
a Member of a Provincial Legislature (or their staff)
a Member of Parliament (or their staff)
a Minister of Religion
a Municipal Clerk
a Notary
an Official of a country with which Canada has a
reciprocal Social Security Agreement
an Official of an Embassy, Consulate or High
Commission
a Pharmacist
a Police Officer
a Postmaster
a Professional Engineer
a Social Worker
a Teacher
ISP-3000-A-00E
Internet Version
Send certified photocopies
instead of original documents (continued)
People who certify photocopies have to compare the
original document to the photocopy and provide the
following information:
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state their official position or title;
sign and print their name;
provide their phone number; and
include the date they certified the document(s).
They also have to write the following statement on
the photocopy:
This photocopy is a true copy of the original
document which has not been altered in any way.
You cannot certify photocopies of your own
documents, and you cannot ask a relative to do it for
you. Please write your Social Insurance Number
on all documents that you send us (except
originals).
Filling out your application
The following information explains how to complete
the application form. Where needed, explanations
have been provided. These explanations match the
box numbers on the application form.
If you have any questions, please call us at the
telephone numbers listed in the section called "How
to contact us".
Section A: To be completed by the
applicant
Box 1
Which benefit do you want to apply for?
Be sure to check off which benefit you are applying
for in this box.
Section B: Information about the
applicant
In this section, you will give us the personal
information we need to decide if you are eligible for
the benefit you have applied for.
Page 3 of 12
Box 2A
Your Social Insurance Number
Box 3A
Your marital status
Enter your Social Insurance Number in this box.
Documentation must be submitted with your
application to confirm your current marital status if
you are applying for an Allowance or an Allowance
for the Survivor.
If you do not have a Social Insurance Number, please
contact your nearest Human Resources Development
Canada office to find out how to get one. Even if you
don’t have a Social Insurance Number, we will start
processing your application anyway. We can add
your Social Insurance Number as soon as you give it
to us.
If you have more than one Social Insurance Number,
please attach a note to your application, listing all
numbers assigned to you.
Box 2B
Your date of birth
Please enter your date of birth in this box.
If you have never applied for or received benefits
under the Old Age Security Act or Canada Pension
Plan, we need you to send us the original or a
certified copy of your original birth or baptismal
certificate with the application form. For details on
how to have copies certified, see the section of this
information sheet called "Send certified photocopies
instead of original documents".
For people born in Canada, acceptable birth
certificates are ones issued by a Provincial birth,
marriage or death registration office. If you do not
have one of these documents and you were born in
Canada, you can get a copy of your birth certificate.
Contact the birth, marriage or death registration
office in the province or territory where you were
born. You can usually find the telephone numbers in
the provincial or territorial government listings of the
telephone book (normally listed as a Provincial Vital
Statistics office).
If you cannot get one of the above documents, please
call us. One of our service delivery agents will let
you know what other kind of documents you can use
to confirm your date of birth.
Single
Check this box if you have never been married.
Married
Check this box if you are now married. If you are
applying for an Allowance, documentation must be
submitted with your application to confirm your
current marital status.
Separated
If you are separated, please let us know whether your
separation is voluntary or involuntary. You are
involuntarily separated if you and your spouse or
common-law partner are living in separate dwellings
for reasons beyond your control — for example, you
or your spouse or common-law partner are confined
to a hospital or nursing home.
Common-law
Check this box if you are living common-law. To
support your claim, a Statutory Declaration and
additional documentation must be submitted with your
application. It is important that you contact us for
further instructions.
Widowed
Check this box if you are widowed. If you are
applying for an Allowance for the Survivor,
documentation must be submitted to verify your
marriage or common-law union and your current
marital status.
Divorced
Check this box if you are divorced.
Box 4A
Written communication
In this box, please tell us in which language you
would like to get letters from us. Check only one box.
Box 4B
Verbal communication
Please check the language — English or French —
you would like to use when you talk to us.
You can choose a different language for written
communication than the one you choose for verbal
communication. For example, you can ask to receive
your letters in English, and you can ask to use French
when talking to one of our agents.
ISP-3000-A-00E
Internet Version
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Box 9
Direct Deposit
EXAMPLE OF A VOIDED CHEQUE
John Smithers
221 Arbour Street
Toronto, Ontario M1M 1Z7
You can sign up for Direct Deposit by using Box 9.
The federal government now uses Direct Deposit as
its standard way to make payments to people. The
money goes right into your account at your financial
institution. Although you can still get your payment
by cheque, Direct Deposit offers several advantages:
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if you are sick, on vacation or travelling, you will
still get your payment automatically; and
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Direct Deposit saves money for Canadian
taxpayers, since the federal government has to
print and mail fewer cheques.
How do you sign up for Direct Deposit?
To sign up for Direct Deposit, you can either:
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attach a cheque from your chequing account to
this application form — make sure to write the
word "VOID" across the front of the cheque (see
the following example) and write your Social
Insurance Number on the back; or
complete Box 9 on the application.
If you would like your pension deposited into a
financial institution in the United States, please attach
a note to your application saying so. We will then
send you another form to fill out.
ISP-3000-A-00E
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842
:0164'''0234-5800
INSTITUTION
NUMBER
ACCOUNT
NUMBER
If you answered yes in question 9 and ARE NOT
PROVIDING a voided cheque, you MUST indicate
your branch number, your institution number and
your account number in the blocks at the bottom of
question 9. Please refer to the example above which
identifies the information we need.
Payment outside of Canada
We can deposit your payment into whichever account
you like at any bank, caisse populaire, credit union,
trust company or other financial institution in Canada
or the United States. If, for some reason, we can’t
deposit your payment into your account, we will
automatically send you a cheque.
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"00646'''
BRANCH
NUMBER
there is less risk that your payment will be lost,
stolen or damaged;
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Dollar
your payment will always be on time, and you
can start using the money and earning interest
right away;
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Date
"VOID"
Pay to the
order of
"485"
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Cheque Number:
Old Age Security pension
If you are absent from Canada, you are only entitled
to receive your Old Age Security pension indefinitely
if you have resided in Canada for at least 20 years
after reaching age 18. If, at the time of your
departure, you have resided in Canada for less than
20 years after reaching age 18, you may receive your
pension only for the month of your departure and for
six additional months. After that period, your
payments will be stopped and can only start again if
you resume residence in Canada.
However, if Canada has an international agreement
on social security with a country you resided in or
worked in, that can sometimes allow you to receive
an Old Age Security pension outside of Canada even
though you have less than 20 years of residence in
Canada after age 18. If this applies to you, you will
be informed.
Allowance and Allowance for the Survivor
You may receive the Allowance or Allowance for the
Survivor while you are outside of Canada, but only
for the month of your departure and for six additional
months. After that time, your payment will be
stopped and can only start again if you resume
residence in Canada.
Page 5 of 12
Starting your Old Age Security / Allowance /
Allowance for the Survivor payments (when
residence in Canada is resumed)
Box 12
When would you like your Old Age Security
pension to begin?
To have your payments started again, contact a Human
Resources Development Canada office free of charge
by calling 1 800 277-9914.
You only have to fill out this box if you are applying
for the Old Age Security pension. In this box, let us
know when you would like your Old Age Security
pension to begin.
You will have to provide proof of your original
departure from, and return to Canada. Refer to Box 16
of this information sheet for a listing of acceptable
documents.
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Your Old Age Security pension is taxable. Fill out
Box 10 if you would like to have us take off monthly
voluntary income tax deductions from your Old Age
pension. You should consider your personal tax
situation before choosing an amount. If you are not
sure at this time, you may request it and change the
amount at a later date.
This service is available to Canadian residents only.
Box 11
Guaranteed Income Supplement application
You only need to fill out this box if you are applying
for the Old Age Security pension.
If you want to fill out an application for the
Guaranteed Income Supplement, check off the yes
box.
If we approve your application for an Old Age
Security pension and if you live in Canada and have
little or no income, you may also be eligible to
receive the Guaranteed Income Supplement. The
amount payable is based on your marital status and
your total income. If you are single, we use your
income to determine the amount you should receive.
If you are married or cohabiting in a conjugal
relationship, we use the combined income of you and
your spouse or common-law partner to calculate the
amount you should receive. If you have lived fewer
than 10 years in Canada after you turned 18 years old,
it is also based on how long you have lived in
Canada.
ISP-3000-A-00E
Internet Version
If your application is approved, your pension will
usually begin the later of:
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Box 10
Voluntary income tax deduction
If you answered yes to Box 11, we will send you an
application for the Guaranteed Income Supplement.
You should complete and return this application as
soon as you can so that you do not lose any
Effective date of an Old Age Security pension
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the month after your 65th birthday;
if you apply after your 65th birthday, the 11th
month before the month we receive your
application; or
the month you specify in Box 12.
You will not be paid for any period before the
month you specify.
If you check off "Earliest month eligible" in Box 12,
we will figure out the earliest possible effective date
for your pension. If you apply after your 65th
birthday, you can receive a back payment for up to
11 months from when we receive your application.
However, this retroactive period cannot cover any
months prior to your 65th birthday.
When we review your application, we will also
determine if there are any other choices available to
you. If there are, we will write to you with the full
details and ask you to choose your preferred
effective date. We will do this before we start paying
your Old Age Security pension.
Effective date of an Allowance
If your application is approved, your Allowance will
normally begin the later of:
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the month after your 60th birthday;
the month after your spouse or common-law
partner becomes eligible for a Guaranteed
Income Supplement;
if you apply after your 60th birthday, the 11th
month before the month we receive your
application.
If you apply after your 60th birthday, you can receive
a back payment for up to 11 months from when we
receive your application. This retroactive period
cannot cover any months prior to your 60th birthday,
or the month after your spouse or common-law
partner becomes eligible for a Guaranteed Income
Supplement.
Page 6 of 12
Box 13B
Is your spouse or common-law partner
between 60 and 64 years old?
Effective date of an Allowance for the Survivor
If your application is approved, your Allowance for
the Survivor will normally begin the later of:
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In this box, check whether or not your spouse or
common-law partner is between the ages of 60 and
64.
the month after your 60th birthday;
the month after your spouse or common-law
partner dies;
if you apply after your 60th birthday, the 11th
month before the month we receive your
application.
Box 13C
Your spouse's or common-law partner's name
date of birth and Social Insurance Number
If you apply after your 60th birthday, you can receive
a back payment for up to 11 months from when we
receive your application. This retroactive period
cannot cover any months before your 60th birthday or
the month after the month your spouse or
common-law partner died.
Incapacity
Protection is available for persons who did not apply
for the Old Age Security pension, Allowance or
Allowance for the Survivor since they were unable to
apply or to ask someone to apply on their behalf
because of their medical condition. If you feel this
applies to you, please contact us to obtain a
"Declaration of Incapacity" form.
Section C: Information about your
spouse or common-law
partner
You only need to fill out this section if you are
applying for the Allowance or the Old Age Security
pension. If you are applying for the Allowance for the
Survivor, go directly to Section D.
In this box, please enter your spouse's or
common-law partner's full name, date of birth and
Social Insurance Number, if it is available.
Definition of spouse and common-law partner
Under the Old Age Security Act:
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you are legally married;
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a common-law partner is a person of the
opposite sex or same sex who has been living in
a conjugal relationship for at least one year.
If you live with someone who meets the above
definition of spouse or common-law partner, and you
want to apply for an Allowance, please complete
questions 13A through 13C. We will review any
information you provide and will advise you, and/or
your spouse or common-law partner, if you may be
eligible for other benefits under the Old Age Security
Act.
If your spouse or common-law partner is deceased
and you want to apply for an Allowance for the
Survivor, please complete questions 21 through 26.
Section D: Information about your
residence history
Box 13A
Is your spouse or common-law partner
receiving the Old Age Security pension?
In this box, please check whether or not your spouse
or common-law partner is receiving the Old Age
Security pension. If yes, enter either your spouse's or
common-law partner’s Social Insurance Number or
the Old Age Security account number of your
spouse's or common-law partner’s pension.
Box 14
People who can confirm your residence in
Canada
In this box, give full names, addresses, and telephone
numbers of two people who are not related to you by
blood or marriage who can confirm your residence in
Canada. You should give us this information even
if you have lived in Canada all your life.
Providing us with the required information will
ensure that only those entitled to receive Old Age
Security benefits will receive them.
ISP-3000-A-00E
Internet Version
Page 7 of 12
Box 15
Your residence status
Box 16
Your residence history (continued)
To be eligible for an Old Age Security pension,
Allowance or Allowance for the Survivor, you must
be a legal resident of Canada. You are considered to
be a legal resident under the Old Age Security Act if
you are/were a Canadian citizen, permanent resident
or in Canada on a Minister’s Permit on:
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SPECIAL MESSAGE FOR APPLICANTS WITH
MILITARY SERVICE IN THE CANADIAN
ARMED FORCES
If you are/were employed or engaged out of
Canada as a member of the Canadian Forces, or
accompanied your spouse or common-law
partner who is/was so employed or engaged, you
do not have to provide a list of all places you
have lived while serving in the military. Attach a
note indicating "military service" and provide the
following:
the day before your application is approved; or
the day before you stopped living in Canada.
If you were born in Canada, your birth or baptismal
certificate is usually sufficient proof to confirm your
legal residence status as a Canadian citizen. However,
if you became a citizen of another country before
February 15, 1977, you may have given up your
Canadian citizenship. If you are not sure what your
status is, please contact a Citizenship and
Immigration office to obtain confirmation of your
status.
If you were born outside of Canada, one of the
following documents is usually sufficient to confirm
your Canadian citizenship/legal residence status:
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The following documents may be used to prove each
"entry into" and/or "return to" Canada:
ENTRY INTO AND / OR RETURN TO CANADA
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DOCUMENTS TO CONFIRM YOUR CANADIAN
CITIZENSHIP/LEGAL RESIDENCE STATUS
Canadian citizenship /
legal residence status
Acceptable documents
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Canadian Citizen
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Permanent resident
(landed immigrant)
Minister's permit
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Birth/Baptismal certificate
Certificate of Canadian
citizenship
Naturalization certificate
Canadian passport issued in
1970 or later
Canadian immigration
record (for example,
Imm 1000)
Canadian Immigration
stamp in your passport
Minister's Permit
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DEPARTURE FROM CANADA
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In this box, please list all the places where you have
lived from birth to now.
ISP-3000-A-00E
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Stamps in passports
Airline, ship, train or bus tickets
Immigration records such as:
t Canadian Immigration Identification Card
t IMM 1000 - Record of Landing
t IMM 1436 - Request to Amend Immigration
Record of Landing
t IMM 1097/1442 - Visitors Record
t Minister’s Permit
Customs declarations
The following documents may be used to prove each
"departure from" Canada:
Box 16
Your residence history
You have to send us documents that prove your
residence history. You can use the following
documents to prove when you entered Canada and
each time you returned to Canada.
the year and month the assignment began and
when it terminated; and
your military service number or a copy of your
discharge papers.
Stamps in passports
Airline, ship, train or bus tickets
Immigration records of a country other than
Canada
United States documents such as:
t Alien Registration Receipt Card (Green Card)
t Visa
t Customs Declaration
t Letter from U.S. Department of Justice,
Immigration and Naturalization Service
Try to send us a certified copy of your original
document with the application form. For details on
how to certify copies, see the section in this
information sheet called "Send certified photocopies
instead of original documents".
Page 8 of 12
Box 18
Have you ever lived or worked in another
country?
Non-Resident Tax (continued)
If you answer yes in Box 18, you should provide the
name of the country and the insurance number that
country issued to you.
Canada has international social security agreements
with many countries. If you have lived or worked in a
country other than Canada, one of these agreements
may apply to you. This is especially important if you
do not meet the minimum residence requirements for
a Canadian Old Age Security pension, Allowance or
Allowance for the Survivor.
An international social security agreement can help
you qualify even if you have as little as one year of
residence in Canada after you turned 18. The exact
provision depends on the terms of the agreement.
You can also reduce the amount of tax we withhold
from your OAS pension by completing a yearly
"Application by a Non-Resident of Canada for a
Reduction in the Amount of Non-Resident Tax
Required to be Withheld" (Form NR5).
This form can be obtained by writing to the:
International Tax Services Office
Canada Customs and Revenue Agency
2204 Walkley Road
Ottawa, Ontario
K1A 1A8
or by calling:
Outside North America (613) 952-3741 (English)
(613) 954-1368 (French)
Repayment of benefit / Recovery tax
The information you provide may also help you
qualify for a pension from another country. We will
send you a letter to let you know if this applies to
you.
Box 19
Are you considered a resident of Canada for
tax purposes?
In this box, please check off yes or no to answer this
question.
Non-Resident Tax
If you answered no to question 19, it means that you
are a non-resident of Canada for income tax purposes.
In this case, we may deduct a Non-Resident Tax from
your monthly Old Age Security (OAS) pension. The
tax rate is 25% of your monthly OAS pension unless
the country you live in has a tax treaty with Canada
that reduces the rate or exempts you from paying the
tax.
Sometimes you can benefit from paying tax at the
same rate as residents of Canada by filing a yearly
Canadian income tax return. The Canada Customs
and Revenue Agency will determine if you are due
for a refund of any Non-Resident Tax you may have
paid.
ISP-3000-A-00E
Internet Version
The amount of Old Age Security (OAS) pension paid
may be reduced through a provision of Canada’s
Income Tax Act. For Canadian residents, this
provision is called the OAS Repayment. For
non-residents of Canada it is called the OAS
Recovery Tax. For 2000, the Repayment or
Recovery Tax applies to persons whose total income
exceeds $53,960 in Canadian dollars. For
non-residents, the OAS Recovery Tax may not apply
if the country you live in has a tax treaty with Canada
that exempts you from paying the tax.
The Repayment or Recovery Tax is deducted from
your monthly OAS pension. The amount of the
deduction is calculated by the Canada Customs and
Revenue Agency based on:
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your previous year's Canadian tax return, if you
are a resident of Canada for tax purposes; or
your previous year's net world income, if you are
a non-resident of Canada for tax purposes.
VERY IMPORTANT
If you are a non-resident of Canada for tax purposes,
Canada Customs and Revenue Agency will send you
the Old Age Security Return of Income (OASRI)
form in February each year. Regardless of your
income, you must file this return by April 30th every
year. If you do not, your Old Age Security pension
will be stopped in July.
Page 9 of 12
Try to send us a certified copy of your original
document with the application form. For details on
how to certify copies, see the section in this
information sheet called "Send certified photocopies
instead of original documents".
Section E: Information about your
deceased spouse or
common-law partner
You only need to fill out this section if you are
applying for an Allowance for the Survivor.
Section F: Applicant's declaration
Box 22A
Your deceased spouse's or common-law
partner’s Social Insurance Number
To complete the application, you have to sign and
date it in this section.
In this box, please enter your deceased spouse's or
common-law partner’s Social Insurance Number, if
you know it.
Section G: Witness's declaration
Box 22B
When did your spouse or common-law
partner die?
If you had someone else fill out the form for you, that
person also has to sign and date it, and include their
name, address, relationship to you, and telephone
number in case we need to contact that person.
Please enter the date of death of your spouse or
common-law partner in this box.
To apply for an Allowance for the Survivor, you have
to send us proof of your spouse's or common-law
partner’s date of death. We can only accept the
document as proof if it shows the name, date and
place of death. The document must also be on official
letterhead or contain a seal, and provide the name or
signature of the person or authority issuing the
document.
We can accept the following documents as proof of
death:
It is an offence under the Old Age Security Act
for any person to make a false or misleading
statement when completing this application to
obtain benefits. You can be charged with an
offence under the Old Age Security Act and/or
the Criminal Code of Canada. Any benefits to
which there is no entitlement must be repaid.
Other information you should read
before mailing your application
ACCEPTABLE DOCUMENTS FOR PROOF OF DEATH
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Burial or Death Certificate
Certification of Death from another country, if an
agreement on social security exists with that country
Life or Group Insurance Claim along with a
statement signed by a medical doctor
Medical Certification of Death
Memorandum of Notification of Death issued by the
Chief of National Defence Staff
Notarial copy of Letters of Probate
Official Death Certificate
Official Notification from the Public Trustee for a
Province
Registration of Death
Statement of a medical doctor, coroner, or funeral
director
Statement of Verification of Death from the
Department of Veterans Affairs
ISP-3000-A-00E
Internet Version
Before you mail your application
Before you send this application form to us, please
make sure that you have:
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completed, signed and dated your application;
indicated your social insurance number in the
space provided on each page of your application;
and
enclosed certified photocopies or any original
documents we need.
Please refer to the "Document Check List" at the
beginning of this information sheet for the documents
we need.
Page 10 of 12
When we receive your application
Allowance and Allowance for the Survivor
Once we receive your application and any supporting
documents, we will contact you if we need more
information. We will send you a letter once we have
completed our review to let you know if you are
eligible.
If you are receiving an Allowance or an Allowance
for the Survivor, you must contact us whenever you
intend to be outside of Canada for more than 6
consecutive months after the month you leave. If you
do not tell us, you may be overpaid and you will have
to pay the money back. If you are away longer than 7
months, we will stop your allowance. It will only
start once you prove that you have taken up residence
in Canada again.
If you have not heard from us by the time you expect
your first payment, please contact us at the telephone
numbers listed in the section called "How to contact
us" at the beginning of this information sheet.
Allowance and Allowance for the Survivor
recipient reaching age 65
What you must do after your pension starts
If you move
You must tell us if you move, even if your pension or
allowance is being sent to another address or is being
deposited directly into your financial institution
account. This way, we will be able to send you
important information and the tax slips you need for
income tax purposes. Also, if you move outside of
Canada or from one country to another, your tax
status may change. If you do not inform us of an
address change and you should have paid a higher
tax rate, you will have to repay any overpayments.
If you change financial institutions or account
numbers
If your payment is directly deposited, please let us
know if you change financial institutions or account
numbers. Do not close your old account until you are
sure that your pension is being deposited into your
new account.
If you will be away from Canada
Old Age Security pension
If you receive an Old Age Security pension and have
not been a resident of Canada for at least 20 years
after age 18, you must contact us whenever you intend
to be outside of Canada for more than 6 consecutive
months after the month you leave. If you do not tell
us, you may be overpaid and you will have to pay the
money back. If you are away for longer than 7
months, we will stop your pension. It will only start
again once you prove that you have taken up residence
in Canada.
When you turn 65, your Allowance or Allowance for
the Survivor will automatically be replaced by an Old
Age Security pension and a Guaranteed Income
Supplement if you are eligible to receive them. You
do not have to apply. In some cases, we might need
more information before we replace your allowance
with the Old Age Security pension. If this happens,
we will contact you. If, for some reason, you do not
receive the Old Age Security pension and the
Guaranteed Income Supplement the month after you
turn 65, you should contact us.
Changes to marital status - Allowance and
Allowance for the Survivor
You should advise us of any changes in your marital
status as this may affect your payment.
If the Old Age Security, Allowance or Allowance
for the Survivor recipient dies
The estate representative must inform Human
Resources Development Canada as soon as possible
of the death of the recipient. Your estate can receive
benefits for the month of your death. If we do not get
the information quickly enough, any benefits paid
after the month of death will have to be paid back.
Other pensions / benefits
Retirement pension
If you have made contributions to the Canada
Pension Plan and have not yet applied, you can
request an application by contacting us.
Other pensions / benefits
Other benefits payable under the Canada Pension
Plan include Disability benefits, Death benefit,
Survivor’s pension and Children’s benefits.
ISP-3000-A-00E
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Page 11 of 12
Protection of personal information
The information requested is required under the Old
Age Security Act (OAS). We may not be able to give
you a benefit if you do not give us all the information
we need. We will keep this information in the
Personal Information Bank HRDC PPU 116. Your
personal information is governed by the Privacy Act
and we may disclose it where we are authorized to do
so under the OAS Act.
Under the OAS Act and the Privacy Act you have the
right to look at the personal information about you in
your file. You can ask to see your file by contacting a
Human Resources Development Canada office. To
find out how to get your personal information
through the Access to Information Coordinator’s
office, see the Info Source, a directory that lists all
the information banks and the information they
contain. Copies of the Info Source are available in all
Human Resources Development Canada offices.
ISP-3000-A-00E
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Page 12 of 12
Human Resources
Development Canada
Développement des
ressources humaines Canada
Income Security Programs
Programmes de la sécurité du revenu
Protected when completed - B
Personal Information Bank HRDC PPU 116
OAS
For information on the Privacy Act, please
see the information sheet.
Copyright Protected
Application for the Old Age Security Pension, Allowance
and Allowance for the Survivor
It is very important that you:
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send in this form with supporting documents
(see the information sheet for the documents we need); and
use a pen and print as clearly as possible.
FOR OFFICE USE ONLY
Age established
SECTION A - TO BE COMPLETED BY THE APPLICANT
1.
Which benefit do you want to apply for?
Old Age Security Pension
Allowance
Allowance for the Survivor
Please complete Sections B,
C, D and F.
If you are 60 to 64 years old and
your spouse or common-law partner
is eligible to receive the Guaranteed
Income Supplement, please
complete Sections B, C, D and F.
If you are widowed and 60 to 64
years old, please complete
Sections B, D, E and F.
SECTION B - INFORMATION ABOUT THE APPLICANT
2A. Social Insurance Number
2B. Date of Birth
Year
Month
Day
2C. Country of Birth (If born in Canada,
indicate province or territory)
3A. Marital Status
Single
3B. Sex
Married
Common-law
4A. Written Communications (Check one)
Your
Language
Preference
5A.
Separated
English
Mr.
Mrs.
Ms.
Miss
5B. Name at birth, if different
from 5A. (e.g. maiden name,
legal name change, etc.)
Widowed
Divorced
Male
Female
4B. Verbal Communications (Check one)
French
English
Usual First Name and Initial
Last Name
First Name and Initial
Last Name
First Name and Initial
Last Name
French
5C. Name on social insurance
card, if different from 5A.
6.
Province or Territory
7.
City
Mailing Address (No., Street, Apt., P.O. Box, R.R.)
Country other than Canada
Home Address, if different from mailing address (No., Street, Apt., P.O. Box, R.R.)
Province or Territory
Telephone
Number(s)
Postal Code
City
Country other than Canada
8A. Area code and telephone number at home
(
)
-
Postal Code
8B. Area code and telephone number at work
(if applicable)
(
)
Ce formulaire est disponible en français - ISP-3000F
ISP-3000-00E
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Page 1 of 4
-
Social Insurance Number
9.
You can only use Direct Deposit for a financial institution located in Canada. For Direct Deposit to a
financial institution located in the United States, please see the enclosed information sheet.
Direct Deposit
If we approve your application, would you like your benefit payment deposited directly into your account at your financial
institution located in Canada?
If yes, you can attach a sample cheque from your chequing account with the word "VOID" written
No
Yes
across it. Write your Social Insurance Number on the back of the cheque. We will use the
information on the cheque to set up your Direct Deposit. If you cannot attach a sample cheque,
complete the blocks below. See the completed sample in the information sheet to guide you.
Account Number
Institution Number
Branch Number
Name(s) of account holder(s)
Area code and
telephone number
of financial institution
10.
(
-
)
Voluntary Income Tax Deduction
This service is available if you live in Canada.
If we approve your application, would you like us to deduct federal income tax from your monthly payment? If you live in
Quebec, you can also ask us to deduct provincial income tax from your monthly payment.
No
Yes
Indicate the dollar amount you want us to deduct each
month. For Quebec residents, you can choose to have
income tax deducted for either federal, provincial or both.
Federal Income
Tax
$
Quebec Provincial
Income Tax
.00
$
11.
If your Old Age Security pension is approved, do you want to apply for the Guaranteed Income Supplement?
(See the information sheet for more information.)
No
Yes
12.
When would you like your Old Age
Security pension to begin?
Earliest month eligible
.00
Year
OR
Month
SECTION C - INFORMATION ABOUT YOUR SPOUSE OR COMMON-LAW PARTNER
If you are applying for an Allowance for the Survivor, go directly to section D
13A. Is your spouse or common-law partner receiving the Old Age Security Pension?
No
Yes
If yes, under what Social Insurance Number or account
number?
13B. Is your spouse or common-law partner between 60 and 64 years old?
13C. Your spouse's or common-law partner's First Name and Initial
Your spouse's or common-law
partner's date of birth
Year
Month
Yes
No
Last Name
Day
Your spouse's or common-law
partner's Social Insurance
Number, if available.
SECTION D - INFORMATION ABOUT YOUR RESIDENCE HISTORY
14.
a)
Give the following information on two people, not related to you by blood or marriage, with whom we can confirm your residence in
This question should be answered even if you have lived in Canada all your life.
Canada.
Mr.
Mrs.
Ms.
Miss
First Name and Initial
Last Name
(
Province or Territory
Mr.
Mrs.
Ms.
Miss
First Name and Initial
Province or Territory
Internet Version
-
Postal Code
Country other than Canada
Area code and telephone
number
Last Name
(
Mailing Address (No., Street, Apt., P.O. Box, R.R.)
ISP-3000-00E
)
City
Mailing Address (No., Street, Apt., P.O. Box, R.R.)
b)
Area code and telephone
number
)
-
City
Country other than Canada
Page 2 of 4
Postal Code
Social Insurance Number
15.
16.
Which of the following applies to you?
FOR OFFICE USE ONLY
I am a Canadian citizen.
I was admitted to Canada on a Minister's Permit.
I was admitted to Canada under the Canadian
Immigration Act as a permanent resident
(landed immigrant).
I was admitted to Canada under other
circumstances (please attach an explanation).
Residence established
Have you lived in Canada all your life?
Yes
No
Residence status
established
If no, list below all the places where you have lived from birth to the present.
l Include all periods when you were outside Canada for more than six months at a time.
l Do not include changes of residence within the same city, town or village, if within Canada.
l If you need more space, use a separate sheet of paper and attach it to this application.
From
Year
17.
To
Month
Day
Year
Day
If you were born outside of Canada, complete the following:
Year
18.
Date you first
entered Canada
Have you ever lived
or worked in another
country?
No
Month
Yes
FOR OFFICE USE ONLY
Date of arrival
established
Day
Place where you
first entered Canada
If yes, indicate the names of the countries and your insurance numbers.
(If you need more space, use a separate sheet of paper and attach it to
this application.) Also, indicate whether a benefit has been requested.
Country
19.
Country
City, Town or Village
Month
Has a benefit been requested?
Insurance number
a)
Yes
No
b)
Yes
No
c)
Yes
No
Yes
No
Are you considered a
resident of Canada
for tax purposes?
Yes
20A. Are you receiving or have
you ever applied for a
benefit under the:
No
If no, is your net world income for the year 2000
less than $53,960 in Canadian dollars?
(See the information sheet for more information.)
Old Age Security?
Yes
Canada Pension Plan?
No
Yes
20B. If you answered yes to any of the above, provide the Social
Insurance Number or account number under which you applied.
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No
Régime de rentes du Québec?
(Quebec Pension Plan?)
Yes
No
SECTION E - INFORMATION ABOUT YOUR DECEASED SPOUSE OR COMMON-LAW PARTNER
Only complete this section if you are applying for an Allowance for the Survivor
Social Insurance Number
21.
Name of your
deceased spouse or
common-law partner
First Name and Initial
Last Name
FOR OFFICE USE
ONLY
22A. Your deceased spouse's or common-law partner's
Social Insurance Number (if known)
23.
24.
25.
26.
Date of death
established
22B. When did your spouse or common-law partner
die?
(See the information
Year
Month Day
sheet for documents
required.)
Month
Day
Yes
If yes, give the date
of marriage
Year
No
Date of marriage
established
Were you living common-law
with your partner at the time
of death?
Month
Day
Yes
If yes, give the date
you started living
common-law
Year
No
Common-law union
established
Have you remarried since
your former spouse's or
common-law partner's death?
Month
Day
Yes
If yes, give the date
of remarriage
Year
No
Date of marriage
established
Have you lived in a conjugal
relationship since your former
spouse's or common-law partner's
death?
No
Yes
If yes, give the date
you started living
common-law
Year
Month
Day
Common-law union
established
Were you married
at the time of death?
IT IS AN OFFENCE TO MAKE A FALSE OR MISLEADING STATEMENT ON THIS
THIS APPLICATION
SECTION F - APPLICANT'S DECLARATION
I hereby apply for the benefit indicated in Section A. I declare that, to the best of my knowledge, the information on this application
is true and complete. I realize that my personal information is governed by the Privacy Act and can be disclosed where authorized
under the Old Age Security Act.
Year
APPLICANT'S
SIGNATURE
Month
Day
APPLICATION DATE
X
NOTE: We can only accept a signature with a mark (e.g. X) if a responsible person witnesses it.
That person must also complete the declaration below.
SECTION G - WITNESS'S DECLARATION
If someone other than the applicant completed this form, that person must complete this section.
If the applicant signs with a mark, a witness (friend, member of the family, etc.) must complete this section.
I have read the contents of this application to the applicant who appeared to fully understand and who made his or
her mark in my presence.
Name
Relationship to applicant
Telephone number
(
Address
Signature
Date
)
Year
Month
Day
FOR OFFICE USE ONLY
I certify that the applicant is eligible for:
Old Age Security Pension
a) Allowance
a) Allowance for the Survivor
b) Allowance subject to income
requirements
b) Allowance for the Survivor
subject to income requirements
as of the effective Payment date shown.
Effective payment date OAS
Aggregate - OAS
Effective payment date ALW/ALWS
Aggregate - ALW/ALWS
Authorized signature - OAS
Date - OAS
Authorized signature - ALW/ALWS
Date - ALW/ALWS
ISP-3000-01-01E
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Page 4 of 4
Human Resources
Development Canada
Développement des
ressources humaines Canada
Income Security Programs
Programmes de la sécurité du revenu
Human Resources Development Canada Offices
Your form(s) should be mailed to the nearest Human Resources Development Canada (HRDC) office. These
offices are shown below. If you need any help while you are completing your form(s) and you are in Canada
or the United States, you can phone our toll-free number 1-800-277-9914. For people with speech or
hearing impairments using a teletypewriter device (TTD/TTY), call 1-800-255-4786. Our lines are busiest at
the beginning and end of each month, so if your business can wait, it's best to call at other times. Please
have your social insurance number ready. Note: If you are applying from outside of Canada, mail your form to
the office in the province where you last resided.
NEWFOUNDLAND
P.O. Box 9430
St. John's, Newfoundland
A1A 2Y5
PRINCE EDWARD ISLAND
P.O. Box 20105
Sherwood Postal Outlet
Sherwood, Prince Edward Island
C1A 9E3
NOVA SCOTIA
P.O. Box 1687
Postal Station "M"
Halifax, Nova Scotia
B3J 3J4
NEW BRUNSWICK
P.O. Box 250
Fredericton, New Brunswick
E3B 4Z6
QUEBEC
330 Gare-du-Palais Street
P.O. Box 1816
Quebec, Quebec
G1K 7L5
ONTARIO (Scarborough)
P.O. Box 5100
Postal Station "D"
Scarborough, Ontario
M1R 5C8
ONTARIO (Timmins)
70 Cedar Street South
P.O. Bag 2013
Timmins, Ontario
P4N 8C8
ONTARIO (Chatham)
65 William Street South
P.O. Box 2020
Chatham, Ontario
N7M 6B2
MANITOBA AND SASKATCHEWAN
P.O. Box 818
Station Main
Winnipeg, Manitoba
R3C 2N4
ALBERTA / NORTHWEST TERRITORIES
AND NUNAVUT
P.O. Box 2710
Main Station
Edmonton, Alberta
T5J 4C2
BRITISH COLUMBIA AND YUKON
P.O. Box 1177
Victoria, British Columbia
V8W 2V2
ISP-3501-02-01E