Form Isp 1200 PDF Details

When a loved one passes away, dealing with administrative tasks can feel overwhelming. However, certain steps must be taken to ensure that all affairs are managed correctly, including applying for eligible benefits like the Canada Pension Plan Death Benefit. The form designated for this purpose is the ISP 1200. This form serves as an application to request a one-time payment from the Canada Pension Plan to the estate of the deceased. It requires detailed information about the deceased, such as their Social Insurance Number, date of birth, country of birth, sex, date of death, and marital status at the time of death, in addition to specifics about their work and residency history. The application process also involves declaring whether the deceased had ever applied for or received benefits under the Canada Pension Plan, Old Age Security, or the Quebec Pension Plan. For individuals responsible for the funeral expenses or managing the deceased's estate, this form becomes a necessary step in the process. It is crucial to accompany this application with supporting documents highlighted in the instructions and to complete the form with clear and accurate information to avoid delays. This introduction aims to provide a comprehensive overview of the ISP 1200 form, emphasizing its importance, required information, and the role it plays in securing financial assistance during a challenging time.

QuestionAnswer
Form NameForm Isp 1200
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesform isp1200, canada pension plan death benefit application form, canada ca form isp1200, form isp 1200

Form Preview Example

Service

PROTECTED B (when completed)

Canada

Personal Information Bank HRSDC PPU 146

 

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

 

 

FOR OFFICE USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

1A. Social Insurance Number

1B. Date of Birth

 

1C. Country of Birth (If born in Canada,

AGE ESTABLISHED

AA

 

 

 

 

Year Month Day

 

indicate province or territory)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2A. Sex

 

 

2B. Date of Death

 

 

 

ESTABLISHED

PROV.

AA

 

 

 

 

 

 

 

 

Year Month Day

DATE OF DEATH

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

Female

(See the information sheet for a list of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

acceptable proof of date of death documents)

 

 

 

 

 

3. Marital status at the time of death

 

 

 

SURNAME - VALIDATOR

AR

 

(See the information sheet for

Single

Married

 

Separated

 

 

 

 

 

 

 

 

 

 

 

 

 

important information about

 

Common-law

Divorced

 

Surviving spouse or

 

 

 

 

marital status)

 

 

 

common-law partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4A.

Mr.

Mrs.

Usual First Name and Initial

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ms.

Miss

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4B. Name at birth, if different

First Name and Initial

 

Last Name

 

 

 

 

from 4A.

 

 

 

 

 

 

 

 

 

 

 

(e.g. maiden name,

 

 

 

 

 

 

 

 

 

 

legal name change, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4C. Name on social insurance

First Name and Initial

 

Last Name

 

 

 

 

card, if different from 4A.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Home Address at the time of death (No., Street, Apt., R.R.)

 

City

 

 

 

Province or Territory

Country other than Canada

Postal Code

6A. If the address shown in number 5 is outside of Canada, indicate the province or territory in which the deceased last resided.

6B. In which year did the deceased leave Canada?

7. Did the deceased ever live

No

Yes

or work in another country?

 

 

Country

a)

b)

c)

If yes, indicate the names of the countries and insurance numbers. (If you need more space, use the space provided on page 4 of this application). Also, indicate whether a benefit has been requested.

Insurance Number

Has a benefit been requested?

 

Yes

No

 

Yes

No

 

Yes

No

Service Canada delivers Human Resources and Skills Development Canada

programs and services for the Government of Canada.

SC ISP-1200 (2011-11-15) E

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Disponible en français

Social Insurance Number

PROTECTED B (when completed)

8A. Did the deceased ever receive or

Canada Pension Plan?

Old Age Security?

Régime de rentes du Québec?

apply for a benefit under the:

(Quebec Pension Plan)

 

 

 

 

 

Yes

No

Yes

No

Yes

No

8B. If yes to any of the above, provide the Social Insurance Number or account number.

9.Was the deceased or the deceased's spouse eligible to receive Family Allowances or was the deceased, the deceased's spouse or the common-law partner eligible to receive the Child Tax Benefit for any children born after December 31, 1958?

Deceased contributor

Yes

No

Deceased's spouse or common-law partner

Yes

No

SECTION B - INFORMATION ABOUT THE SETTLEMENT OF THE ESTATE

(See "Who should apply for the Death benefit" on the information sheet)

10.Is there a will?

 

Yes

Please provide the name and address of the executor in number 11 and go to section C.

 

 

 

 

No

Go to number 12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR OFFICE

The Estate of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE ONLY

 

 

 

 

 

 

 

 

_A

 

 

 

 

 

 

 

 

 

 

 

11.

Mr.

Mrs.

First Name and Initial

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ms.

Miss

 

 

 

 

 

 

 

 

_B

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (No., Street, Apt., P.O. Box, R.R.)

City

 

 

TYPE

 

FOREIGN

LANG.

 

 

 

NM ADR

 

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_C

Province or Territory

Country other than Canada

 

Postal Code

CONS. CODE

NO. LNS

A.L.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_D

 

 

 

 

 

 

 

 

 

 

 

 

12.There is no will and I am applying for the Death benefit as:

an administrator appointed by the court (Please give your name and address in number 11)

the person responsible for the funeral expenses (You must submit the funeral contract or funeral receipts with your application.) the spouse or common-law partner of the deceased

the next-of-kin (Please specify your relationship)

other (Please specify)

SECTION C - INFORMATION ABOUT THE APPLICANT

13.

Mr.

Mrs. First Name and Initial

Last Name

 

Ms.

Miss

_A

 

 

 

14.Relationship of applicant to the deceased

FOR OFFICE

For the Estate of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (No., Street, Apt., P.O. Box, R.R.)

City

 

TYPE

 

FOREIGN

 

LANG.

 

 

NM ADR

 

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_B

Province or Territory

Country other than Canada

Postal Code

CONS. CODE

NO. LNS

A.L.

 

 

 

 

 

 

20

_C

SC ISP-1200 (2011-11-15) E

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Social Insurance Number

PROTECTED B (when completed)

SECTION D - APPLICANT'S DECLARATION

I hereby apply on behalf of the estate of the deceased contributor for a Death benefit. I declare that, to the best of my knowledge, the information given in this application is true and complete.

NOTE: If you make a false or misleading statement, you may be subject to an administrative monetary penalty and interest, if any, under the Canada Pension Plan, or may be charged with an offence. Any benefits you received or obtained to

which there was no entitlement would have to be repaid.

APPLICANT'S

Year Month Day

SIGNATURE

APPLICATION DATE

TELEPHONE

NUMBER

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 E - WITNESS'S DECLARATION

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

 

 

 

 

 

 

 

 

BENEFIT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMBER OF LINES

 

 

 

 

 

APP. REC'D

 

DT. EFF.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

ACTION

BNFT

AL

B/C

D

 

E

F

 

G

S

 

CPP NUMBER

Y M D

 

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D T H

2 0

0 0

0 0

EA

MONETARY INFO

 

 

CHILD

 

RECOVERY

CODE

 

 

BNFT

 

CHILD

 

SQNC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

ACCRUED RECOVERY

 

DT EFF.

 

 

CPP WITHHOLD

 

 

QPP WITHHOLD

SIGN

 

UNDER/OVPMNT

CPP

QPP

 

M

 

Y

 

 

 

ARREARS

RATE

 

 

ARREARS

RATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FA - CTB PERIODS

 

 

 

 

 

 

 

 

START

 

 

 

END

 

 

 

START

 

 

END

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

M

D

 

Y

M

D

 

 

Y

M

D

Y

M

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FA FA FB

(1)

 

 

 

GB

 

(3)

 

 

(2)

 

 

 

GB

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application taken by: (Please print name and phone number)

Application approved pursuant to the Canada Pension Plan.

Date

 

 

Authorized Signature

 

 

GB

GB

DATE

TYPE OF

BATCH NO.

CYCLE

DATE

SIGNATURE

REJECT

 

 

 

 

 

1

2

3

4

SC ISP-1200 (2011-11-15) E

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Social Insurance Number

PROTECTED B (when completed)

Use this space, if needed, to provide us with more information. Please indicate the question number concerned for each answer given. If you need more space, use a separate sheet of paper and attach it to this application.

SC ISP-1200 (2011-11-15) E

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Service

Canada

Service Canada Offices

Canada Pension Plan

Mail your forms to:

The nearest Service Canada office listed below.

From outside of Canada: The Service Canada office in the province where you last resided.

Need help completing the forms?

Canada or the United States: 1-800-277-9914

All other countries: 613-990-2244 (we accept collect calls)

TTY: 1-800-255-4786

Important: Please have your social insurance number ready when you call.

NEWFOUNDLAND AND LABRADOR

Service Canada

PO Box 9430 Station A

St. John's NL A1A 2Y5

CANADA

PRINCE EDWARD ISLAND

Service Canada

PO Box 8000 Station Central

Charlottetown PE C1A 8K1

CANADA

NOVA SCOTIA

Service Canada

PO Box 1687 Station Central

Halifax NS B3J 3J4

CANADA

NEW BRUNSWICK AND QUEBEC

Service Canada

PO Box 250 Station A

Fredericton NB E3B 4Z6

CANADA

ONTARIO

For postal codes beginning with "L, M or N" Service Canada

PO Box 5100 Station D

Scarborough ON M1R 5C8

CANADA

ONTARIO

For postal codes beginning with "K or P" Service Canada

PO Box 2013 Station Main

Timmins ON P4N 8C8

CANADA

MANITOBA AND SASKATCHEWAN

Service Canada

PO Box 818 Station Main

Winnipeg MB R3C 2N4

CANADA

ALBERTA / NORTHWEST TERRITORIES AND NUNAVUT

Service Canada

PO Box 2710 Station Main

Edmonton AB T5J 2G4

CANADA

BRITISH COLUMBIA AND YUKON

Service Canada

PO Box 1177 Station CSC

Victoria BC V8W 2V2

CANADA

Disponible en français

SC ISP-3501-CPP (2011-11-15) E

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Be mindful when filling out this document. Make certain all necessary fields are filled out properly.

1. First, when filling in the form isp 1200, start with the form section that has the subsequent fields:

Filling out part 1 in isp 1200a pdf

2. The next step is usually to fill out all of the following fields: A If the address shown in number, B In which year did the deceased, or territory in which the deceased, Canada, Did the deceased ever live or, Yes, If yes indicate the names of the, Country, Insurance Number, Has a benefit been requested, Yes, Yes, Yes, Service Canada delivers Employment, and programs and services for the.

isp 1200a pdf conclusion process explained (part 2)

3. Completing A Did the deceased ever receive or, Canada Pension Plan, Old Age Security, Quebec Pension Plan, Yes, Yes, Yes, If yes to any of the above provide, Was the deceased or the deceaseds, Deceased contributor, Yes, Deceaseds spouse or commonlaw, Yes, SECTION B INFORMATION ABOUT THE, and See Who should apply for the Death is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Tips on how to fill out isp 1200a pdf portion 3

4. It's time to fill in the next section! In this case you'll have all of these There is no will and I am, an administrator appointed by the, the person responsible for the, the spouse or commonlaw partner of, the nextofkin Please specify your, other Please specify, SECTION C INFORMATION ABOUT THE, Optional, First Name and Initial, Last Name, Mrs, Miss, Relationship of applicant to the, FOR OFFICE, and USE ONLY empty form fields to do.

The best ways to fill in isp 1200a pdf part 4

5. Because you come close to the completion of this file, you will find a few more requirements that need to be met. Notably, Province or Territory, Country other than Canada, Postal Code, and SC ISP E must be filled in.

Completing part 5 of isp 1200a pdf

Be extremely careful when filling out Postal Code and SC ISP E, as this is the section in which most users make some mistakes.

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