Sc Isp 3004 E Form PDF Details

The SC ISP-3004 E form is a foundational document that facilitates the recognition of common-law unions under the auspices of Canadian law, specifically in relation to the Canada Pension Plan and the Old Age Security Act. This statutory declaration plays a pivotal role in identifying partners as common-law spouses by providing concrete proof of their domestic arrangement. It requires detailed personal information, including Social Insurance Numbers, and necessitates declarations regarding the duration of cohabitation, the existence of children within the union, shared financial responsibilities, joint ownership of property, and arrangements concerning life insurance. Significantly, this document underlines the gravity of submitting truthful and accurate information, highlighting potential consequences for misinformation, such as administrative penalties or the obligation to repay any benefits unjustly received. The form also accommodates those acting on behalf of an applicant, specifying the need for authorized evidence of this representation. By fulfilling and submitting the SC ISP-3004 E, individuals engage in a crucial step for gaining entitlements potentially due under key social welfare programs, all the while adhering to the stringent privacy and verification measures governed by relevant Canadian legislation. This form exemplifies the bureaucratic, though necessary, path toward safeguarding partners' rights and accessing benefits in a common-law union setting.

QuestionAnswer
Form NameSc Isp 3004 E Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesontario peace bond application form, canada declaration common law union, form isp 3004, canada form common law

Form Preview Example

Service

 

PROTECTED B (when completed)

Canada

Statutory Declaration of Common-law Union

Personal Information Bank

 

ESDC PPU 116 and 146

 

 

(Dual signatures)

 

Social Insurance Number

 

SECTION A - TO BE COMPLETED BY THE APPLICANT

 

 

 

Canada

 

 

 

 

 

 

 

In the Matter of the Canada Pension Plan and the

 

 

 

 

 

 

To Wit:

 

 

 

Old Age Security Act and

PROVINCE / TERRITORY OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In the Matter of Common-Law Union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the (City, Town, Village) of

 

 

county of

 

 

 

 

in the province / territory of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Solemnly Declare, that

 

 

 

 

 

 

 

name of common-law partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and I have been

 

 

continuous year(s) from

 

 

 

 

 

 

to

 

 

 

.

living together for

 

 

 

 

 

 

 

 

 

 

 

 

 

number of years

 

 

 

 

YYYY-MM-DD

 

 

 

 

 

YYYY-MM-DD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Are there children of the common-law union? This would include adopted children or

 

No

 

Yes

If yes, please provide the

children of one common-law partner to whom the other acts or has acted as a parent.

 

 

following information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The following is information on each child. (If more space is required, attach a separate sheet.)

 

 

 

 

 

 

 

 

 

First Name

 

Legal Family Name

 

Family Name commonly used

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.My common-law partner and I:

a)Jointly signed a residential lease, mortgage or purchase agreement relating to a residence in which we both live(d).

Yes No

b)Jointly owned property other than our residence.

Yes No

c)Have/had joint bank, trust, credit union or charge card accounts.

Yes No

3A. I have life insurance on myself that names my common-law partner as

3B. My common-law partner has life insurance on him/herself that

beneficiary.

 

names me as beneficiary.

 

Yes

No

Yes

No

4.If none of the above sections apply, what other documentary evidence are you aware of that would support your conjugal relationship as common-law partners?

I hereby declare that, to the best of my knowledge, the information on this declaration is true and complete. I realize that my personal information is governed by the Privacy Act and may be disclosed where authorized under the Old Age Security Act and the Canada Pension Plan.

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 the Old Age Security Act, or may be charged with an offence. Any benefits you received or obtained to which there was no entitlement would have to be repaid.

Your Name (Please print)

Your Signature

 

 

Name of Common-law Partner (Please print)

Signature of Common-law Partner

Was the form completed and signed by someone other than the applicant?

If yes, that person must complete the section below and submit proof that they are authorized to act on behalf of the client. Call us at 1-800-277-9914 to find out what documents are required.

Name

 

Relationship to applicant

 

 

 

 

 

Telephone number

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B - TO BE COMPLETED BY THE COMMISSIONER FOR OATHS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Declared before me at

 

 

, county of

 

 

 

 

,

 

 

name of city, town or village

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

county

 

 

 

 

 

in the province or territory of

 

 

 

this

day of

,

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

province or territory

 

 

 

 

day

 

month

 

 

year

Name of Commissioner and Organization (Please print)

Signature of Commissioner

Commissioner Authority Number (if applicable)

Service Canada delivers Employment and Social Development Canada

programs and services for the Government of Canada

SC ISP-3004 (2014-08-01) E

Disponible en français

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

How to Edit Sc Isp 3004 E Form Online for Free

With the help of the online tool for PDF editing by FormsPal, it is possible to fill out or modify canada statutory common law right here. Our editor is constantly developing to give the best user experience attainable, and that is due to our commitment to continual development and listening closely to customer feedback. With a few basic steps, you can start your PDF journey:

Step 1: Access the PDF file inside our tool by hitting the "Get Form Button" at the top of this webpage.

Step 2: This editor lets you modify almost all PDF forms in many different ways. Change it by writing customized text, adjust what is already in the file, and add a signature - all manageable in minutes!

This PDF doc will require specific details; in order to ensure accuracy and reliability, you need to take heed of the tips below:

1. It is advisable to complete the canada statutory common law accurately, so be careful while working with the parts containing these specific fields:

Filling out part 1 in canada form common law

2. After this part is complete, it's time to add the essential specifics in A I have life insurance on myself, B My commonlaw partner has life, beneficiary, Yes, names me as beneficiary, Yes, If none of the above sections, commonlaw partners, I hereby declare that to the best, Your Name Please print, Your Signature, Name of Commonlaw Partner Please, Signature of Commonlaw Partner, Was the form completed and signed, and Telephone number so you can move on further.

Yes, If none of the above sections, and I hereby declare that to the best of canada form common law

3. Completing Name of Commissioner and, Signature of Commissioner, Commissioner Authority Number if, province or territory, day, month, year, Service Canada delivers Employment, programs and services for the, SC ISP E, and Disponible en français is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

programs and services for the, year, and month inside canada form common law

Regarding programs and services for the and year, ensure that you double-check them here. The two of these could be the most significant ones in the page.

Step 3: After you've looked again at the details in the file's blank fields, click on "Done" to complete your form. Download the canada statutory common law when you join for a free trial. Immediately use the pdf file from your FormsPal cabinet, together with any edits and changes being automatically kept! FormsPal is committed to the privacy of our users; we make sure all personal data handled by our editor is secure.

Sc Isp 3004 E Form isn’t the one you’re looking for?

Related Documents