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.

Application for a Canada Pension Plan Death Benefit. It 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 possible. SECTION A - INFORMATION ABOUT THE DECEASED. 1A. Social Insurance Number. 1B. Date of Birth YYYY-MM-DD. 1C.

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