Sc Isp 3004 E Form PDF Details

Are you looking to make life simpler by using an eForm rather than a paper document to complete your SC ISP 3004 requirements? This post will provide you with the information and guidance you need to get started. We'll walk through what this form is, why it exists, and how you can use it. Plus we'll answer any questions that come up along the way so that filing the SC ISP 3004 eForm is as straightforward as possible. Whether it's your first time completing this task or you've done it multiple times before, this guide should simplify things significantly! So grab a cup of coffee (or tea!) and let's get started.

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

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