Blank Isp 3000 Oas Application PDF Template

Qualifying for the Old Age Security

To receive the Old Age Security (OAS) pension you must:

!be 65 years of age or older;

!have a legal residence status in Canada;

!meet the residence requirements;

!submit the necessary documents; and

!complete and sign the application.

If you now live outside Canada, you must have been a legal resident of Canada the day before you left Canada.

Social Security Agreements

Canada has social security agreements with many countries that could help you meet the residence requirements to qualify for the OAS. If you lived or worked in one or more of these countries, you may also qualify for benefits from these countries. We will send you an application form if necessary.

When to apply

You can apply for the OAS pension up to 12 months before your 65th birthday. If you have already reached age 65, send your application as soon as possible so you won't lose any payments.

Please note that we can pay your pension back to a maximum of 11 months from the date we receive your application, but no earlier than the month after your 65th birthday.

Unable to apply

If you intended to apply sooner, but a medical condition kept you from doing so and you were unable to ask someone to apply for you, please contact us to obtain a form called "Declaration of Incapacity". By filling out and returning this form, you will ensure that your pension starts with the earliest possible effective date.

Documents Required

Proof of birth

(Refer to question 4 on the application)

If you have never applied for or received benefits from the Old Age Security program or the Canada Pension Plan, you must provide us with your birth or baptismal certificate or a certified photocopy of one of these documents. If you are unable to obtain one of these documents, please contact us.

Proof of Canadian legal residence status (Refer to question 13 on the application)

To be eligible for the OAS pension, you must be a legal resident of Canada. You are considered to be a legal resident if you are a Canadian Citizen, a permanent resident (formerly called Landed Immigrant) or

in Canada under a Minister's Permit on the day before your application is approved or the day before you leave Canada.

If you were born in Canada and have lived in

Canada all your life, you only need to submit a certified photocopy of your birth or baptismal certificate to prove your legal residence status.

If you moved outside of Canada and 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.

If you were born outside of Canada, a certified photocopy of one of the following documents is usually sufficient to confirm your Canadian citizenship or legal residence status:

!Canadian Citizen - Certificate of Canadian citizenship, naturalization certificate, or Canadian passport issued in 1970 or later;

!Permanent Resident (formerly known as Landed Immigrant) - Canadian immigration documents (for example IMM1000 - Record of Landing or Permanent Resident Card) or Canadian immigration stamp on your passport;

!Resident under a Minister's Permit - Minister's Permit.

Proof of residence history

(Refer to question 15 on the application)

If you have not lived in Canada all your life, you must send us certified photocopies of documents that prove your history of residence in Canada. You can use the following documents to prove when you entered, departed or returned to Canada:

!passports;

!immigration records (such as visas);

!customs declarations; or

!other approved documents that can prove your history of residence in Canada.

Certified photocopies of original documents

It is better to send certified photocopies of documents rather than the originals. If you choose to send original documents, send them by registered mail. We will return the original documents to you.

We can only accept a photocopy of an original document if it is legible and if it is a certified true copy of the original. Our staff at any Human Resources Center of Canada (HRCC) will photocopy your documents and certify them free of charge. If you cannot visit an HRCC office, you can ask one of the following people to certify your photocopy:

!an Accountant;

!a Commissioner of Oaths

!a Teacher

!a Doctor, a Dentist, a Chiropractor, a Pharmacist

!the Manager of a financial institution

!an Employee of a federal or provincial government department

!a Funeral Director

!a Justice of the Peace

!a Lawyer, a Notary, a Magistrate

!a Member of a Provincial Legislature (or their staff)

!a Member of Parliament (or their staff)

!a Minister of Religion

!a Municipal clerk

!an Official of a country with which Canada has a reciprocal Social Security Agreement

!an Official of an Embassy, Consulate or High Commission

!a Police Officer

!a Postmaster

!a Professional Engineer

!a Social Worker

People who certify photocopies must compare the original document to the photocopy, state their official position or title, sign and print their name, give their telephone number and indicate the date they certified the document. They must also 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.

If a document has information on both sides, both sides must be copied and certified.

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 any photocopies that you send us.

Guaranteed Income Supplement (GIS)

(Refer to question 12 on the application)

The GIS is a non-taxable monthly benefit paid to residents of Canada who receive an OAS pension and who have little or no other income. GIS payments may begin in the same month as OAS pension payments.

To receive the GIS, you must:

!be 65 years of age or older;

!be a resident of Canada;

!have a low income; and

!be in receipt of the OAS pension.

If you wish to be considered for GIS, please check "yes" in question 12 and we will send you a form with more information. You may also obtain the GIS application form on our Internet site at www.hrdc-drhc.gc.ca and mail it with your OAS application.

Allowance

If you qualify for the GIS and have a spouse or common-law partner* between the ages of 60 and 64, he or she may be entitled to receive the Allowance.

The Allowance is a non-taxable monthly benefit paid to the spouse or common-law partner of someone who is receiving the OAS pension and who qualifies for the GIS.

If this is your situation, we will send your spouse or common-law partner a form with more information.

*A common-law partner is a person of the opposite or same sex who has been living with you in a conjugal relationship for at least one year.

Taxes and your pension

Income tax

Your OAS pension is taxable. We will not deduct income tax from your monthly payment unless you request it. Once we have approved your pension, we will send you a letter stating the amount of your pension. It will give you information on how to ask for income tax to be deducted.

You may also obtain the tax deduction request form on our Internet site at www.hrdc-drhc.gc.ca and mail it with your application.

Non-Resident Tax

If you live outside Canada, we may deduct a Non-Resident Tax from your monthly OAS pension. The tax rate is 25% of your monthly OAS pension unless you live in a country that has a tax treaty with Canada.

Repayment of Benefit or Recovery Tax (If your net world income* is more than $59,790 - Refer to question 17 on the application)

*Net world income means all the income that you earn or receive in a year from sources in Canada and outside Canada. This includes total income derived from sources such as employment, business, pensions, rental property and investments, minus allowable deductions.

Under a provision of Canada's Income Tax Act, the amount of OAS pension that you receive may be reduced. For Canadian residents, this provision is called the OAS Repayment. For non-residents of Canada it is called the OAS Recovery Tax. For non-residents, the OAS Recovery Tax may not apply if the country you live in has a tax treaty with Canada.

The Canada Revenue Agency calculates the amount of the Repayment or Recovery Tax deduction that is withheld from your monthly OAS pension. If you are a resident of Canada, the amount of the deduction is based on information found on your previous year's Canadian tax return. If you are a non-resident of Canada, the amount of the deduction is based on your previous year's net world income.

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 authorised 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 an Income Security Programs 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 Income Security Programs offices.

For more information

In Canada and United States,

English: 1 800 277-9914

French: 1 800 277-9915

For TTY/TDD users who have speech or hearing impairments: 1 800 255-4786

(Please have your Social Insurance Number ready when you call.)

You can also visit our Internet site at

www.hrdc-drhc.gc.ca.

Note: This document contains general information concerning the Old Age Security (OAS) pension and reflects the OAS legislation. If there are any differences between what is in this document and the OAS Act, the Act is always right.

1Social Insurance Number

2First name, initial and last name

Mr Mrs Miss Ms

3Name at birth (If different from above)

4Date of birth (You must provide a proof of birth. See the information sheet under "Documents Required".)

Year Month Day

5Country of birth

6Preferred language for correspondence

English French

7Home address

Postal code

Telephone number during the day

8Mailing address (If different from home address)

Postal code

Protected when completed-B

Personal Information Bank HRDC PPU 116

9Direct deposit (For Canada only)

For deposits outside of Canada, please contact us.

Do you want your monthly payments deposited into your account at your financial institution?

No (Go to question 10)

Yes (Complete this section)

If you have a chequing account, please attach an unsigned personalized cheque. Write the word "VOID" on the front of the cheque and your social insurance number on the back.

If you have a savings account, complete the boxes below (you may want to contact your financial institution to get this information):

Account number

Name(s) on the account

Telephone number of your financial institution

10Current marital status (This information may help us determine eligibility to other benefits.)

Single Married Common-law

Separated Divorced Widowed

If your marital status is married or common-law, please provide the following information:

First name, initial and last name of your spouse or common-law partner

Date of birth

Year Month Day

Social Insurance Number

Ce formulaire est disponible en français.

ISP-3000-E-17-02-04 Internet Version

11When do you want your pension to start?

(See the information sheet under "When to apply".)

As soon as I qualify or

(Indicate a date)

Year Month

Note: If you indicate a date, no payment will be made for any period before that date, even if you qualify before.

12Guaranteed Income Supplement

(See information sheet under "Guaranteed

15Residence history

Have you lived in Canada all your life?

Yes (Go to Question 18)

No, list below all places where you have lived from age 18 to the present. Do not include periods when you were outside Canada for less than six months at a time.

(You must provide proof of your residence history.

See the information sheet under "Documents Required".)

Income Supplement".)

If your Old Age Security pension is approved, do you want to apply for the Guaranteed Income Supplement?

Yes No

13Canadian legal residence status

(You must provide proof of your residence status. See the information sheet under "Documents Required".)

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

Year Month Day

If you are living in Canada now, indicate your current legal residence status.

OR

If you are living permanently outside Canada, indicate what your legal residence status was immediately before you left.

Canadian Citizen

Permanent Resident (formerly known as Landed Immigrant)

Resident under a Minister's Permit

Other (please specify)

14If you were born outside Canada, please indicate:

The date you first entered Canada

Year Month Day

The city where you first entered Canada

(If you need more space, use a separate sheet of paper.)

16Benefits from other countries (See the

information sheet under "Social Security Agreements".)

If you have lived or worked in a country other than Canada, you could qualify for benefits from that country. Please provide the following information:

Country

Period lived:

to

(If you have lived or worked in more than one country, use a separate sheet of paper.)

17If you are not considered a resident of Canada for tax purposes, is your net world income for the year 2004 more than

(See information sheet under "Taxes and your pension".)

18Give the following information about one person, not related to you by blood or marriage, with whom we can confirm your residence in Canada. Please note that if for any reason we lose contact with you, we could contact that person to get in touch with you.

First name, initial and last name

Mr Mrs Miss Ms

Mailing address

Postal code

Telephone number during the day

SIGNATURE

It is an offence to knowingly make a false or misleading statement on this application.

I declare that the information on this application is true and complete. I realize that my personal information is governed by the Privacy Act and may be disclosed where authorized under the

Signature with a mark or by someone other than the applicant

If you (the applicant) signed with a mark (for example "X"), the mark must be made in the presence of a witness.

If the application was signed by someone who has the authority to act on behalf of the applicant, that person must provide proof of authorization (contact us to find out what documents are required).

In either situation, the witness or the person who signed the application on behalf of the applicant must provide the following information:

First name, initial and last name

Relationship to the applicant

Address

Postal code

Telephone number during the day

If the applicant signed with a mark, the witness must also sign the following declaration:

I have read the content of this application to the applicant who appeared to fully understand and who made his or her mark in my presence.

Witness's signature

4

Date

Year Month Day

FOR OFFICE USE ONLY

Old Age Security Act.

Applicant's signature

4

Date

Effective Date

Year Month

Aggregate:

4

Signature

Date Stamp

Year Month Day

Year Month Day

NEWFOUNDLAND AND LABRADOR

Human Resources Development Canada

P.O. Box 9430

St. John's NL A1A 2Y5

PRINCE EDWARD ISLAND

Human Resources Development Canada

P.O. Box 20105

Sherwood Postal Outlet

Sherwood PE C1A 9E3

NOVA SCOTIA

Human Resources Development Canada

P.O. Box 1687

Postal Station "M"

Halifax NS B3J 3J4

NEW BRUNSWICK

Human Resources Development Canada

P.O. Box 250

Fredericton NB E3B 4Z6

QUEBEC

Human Resources Development Canada

P.O. Box 1816

Quebec QC G1K 7L5

ONTARIO (Scarborough)

Human Resources Development Canada

P.O. Box 5100

Postal Station "D"

Scarborough ON M1R 5C8

ONTARIO (Timmins)

Human Resources Development Canada

P.O. Bag 2013

Timmins ON P4N 8C8

ONTARIO (Chatham)

Human Resources Development Canada

P.O. Box 2020

Chatham ON N7M 6B2

MANITOBA AND SASKATCHEWAN

Human Resources Development Canada

P.O. Box 818

Station Main

Winnipeg MB R3C 2N4

ALBERTA / NORTHWEST TERRITORIES AND NUNAVUT

Human Resources Development Canada

P.O. Box 2710

Main Station

Edmonton AB T5J 4C2

BRITISH COLUMBIA AND YUKON

Human Resources Development Canada

P.O. Box 1177

Victoria BC V8W 2V2