Transcription of Application for CPP Death Benefit - Service Canada
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Application for CPP Death Benefit - Service Canada
PROTECTED B (when completed)SC ISP-1200 (2021-07-09) E1 of 4 Service CanadaPersonal Information Bank ESDC PPU 146 Application for a Canada Pension Plan Death BenefitIt is very important that you:- 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 A - INFORMATION ABOUT THE DECEASED1A. Social Insurance Number1B. Date of Birth YYYY-MM-DD1C. Country of Birth (If born in Canada , indicate province or territory)2. Date of Death (See the information sheet for a list of acceptable proof of date of Death documents)YYYY-MM-DDFOR OFFICE USE ONLYAGE ESTABLISHEDDATE OF Death ESTABLISHED3. Marital status at the time of Death (See the information sheet for important information about marital status)SingleMarriedSeparatedCommon-lawD ivorcedSurviving spouse or common-law First name and InitialLast name at birth, if different from name and InitialLast on social insurance card, if different from name and InitialLast Address at the time of Death (No.)
Usual First Name and Initial Last Name. 4B. Full name at birth, if different from 4A. First Name and Initial Last Name. 4C. Name on social insurance card, if different from 4A. First Name and Initial. Last Name. 5. Home Address at the time of death (No., Street, Apt., R.R.) City, Town or Village Province or Territory Country other than Canada ...
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