Form SC ISP-1200 "Application for Canada Pension Plan Death Benefit" - Canada

What Is Form SC ISP-1200?

Form SC ISP-1200, Application for Canada Pension Plan Death Benefit, is a formal statement prepared by eligible individuals who wish to receive a lump-sum payment on behalf of a deceased person who has contributed to the Canada Pension Plan (CPP). With a will or without it, the executor of the estate or the deceased's relatives can fill out this document to apply for the one-time payment.

Alternate Names:

  • CPP Death Benefit Application Form;
  • CPP Death Benefit Form.

This form was issued by Service Canada, a program under the control of Employment and Social Development Canada, on December 19, 2018, with all previous editions obsolete. You can download a fillable CPP Death Benefit Form below.

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CPP Death Benefit Form Instructions

Here is how you need to complete Form SC ISP-1200:

  1. Provide information about the deceased individual. Record their social insurance number, date and place of birth, date of death, and marital status at the time of death. State their full name, name at birth, and name on the social insurance card. Write down their address at the time of death or name the Canadian province they last resided in and specify when they left the country.
  2. Answer several questions about the deceased person - whether they lived or worked abroad, received benefits, or were eligible for Family Allowances or Child Tax Benefit.
  3. Describe the estate of the deceased - name the estate executor and indicate their address. If there is no will, check the appropriate circle to specify your status.
  4. Provide your personal information - full name, relationship to the deceased, preferred languages, and mailing address.
  5. Certify all the information in the document is true and complete, provide your telephone number, sign and date the form. If you sign with a mark, it is necessary to find an individual who will witness your signature and also sign the document.
  6. Use the blank page if you have to elaborate on certain questions.
  7. Send the form to your local Service Canada office or the office located in the province you last lived in - find the appropriate address on the last page of the form.
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Download Form SC ISP-1200 "Application for Canada Pension Plan Death Benefit" - Canada

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Service
PROTECTED B (when completed)
Canada
Personal Information Bank ESDC 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
1A. Social Insurance Number
1B. Date of Birth
1C. Country of Birth (If born in Canada,
FOR OFFICE USE ONLY
YYYY-MM-DD
indicate province or territory)
AGE ESTABLISHED
DATE OF DEATH ESTABLISHED
2.
Date of Death
YYYY-MM-DD
(See the information sheet for a list of acceptable proof
of date of death documents)
3.
Marital status at the time of death
Single
Married
Separated
(See the information sheet for important
information about marital status)
Surviving spouse or
Common-law
Divorced
common-law partner
4A. Optional
Usual First Name and Initial
Last Name
Mr.
Mrs.
Ms.
Miss
4B. Full name at birth,
First Name and Initial
Last Name
if different from 4A.
4C. Name on social
First Name and Initial
Last Name
insurance card,
if different from 4A.
5.
Home Address at the time of death (No., Street, Apt., R.R.)
City, Town or Village
Province or Territory
Country other than Canada
Postal Code
6A. If the address shown in number 5 is outside of Canada, indicate the province
6B. In which year did the deceased leave
or territory in which the deceased last resided.
Canada?
7.
Did the deceased ever live or work in another country?
No
Yes
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.
Country
Insurance Number
Has a benefit been requested?
a)
No
Yes
b)
No
Yes
c)
Yes
No
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada.
SC ISP-1200 (2018-12-19) E
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Disponible en français
Service
PROTECTED B (when completed)
Canada
Personal Information Bank ESDC 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
1A. Social Insurance Number
1B. Date of Birth
1C. Country of Birth (If born in Canada,
FOR OFFICE USE ONLY
YYYY-MM-DD
indicate province or territory)
AGE ESTABLISHED
DATE OF DEATH ESTABLISHED
2.
Date of Death
YYYY-MM-DD
(See the information sheet for a list of acceptable proof
of date of death documents)
3.
Marital status at the time of death
Single
Married
Separated
(See the information sheet for important
information about marital status)
Surviving spouse or
Common-law
Divorced
common-law partner
4A. Optional
Usual First Name and Initial
Last Name
Mr.
Mrs.
Ms.
Miss
4B. Full name at birth,
First Name and Initial
Last Name
if different from 4A.
4C. Name on social
First Name and Initial
Last Name
insurance card,
if different from 4A.
5.
Home Address at the time of death (No., Street, Apt., R.R.)
City, Town or Village
Province or Territory
Country other than Canada
Postal Code
6A. If the address shown in number 5 is outside of Canada, indicate the province
6B. In which year did the deceased leave
or territory in which the deceased last resided.
Canada?
7.
Did the deceased ever live or work in another country?
No
Yes
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.
Country
Insurance Number
Has a benefit been requested?
a)
No
Yes
b)
No
Yes
c)
Yes
No
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada.
SC ISP-1200 (2018-12-19) E
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Disponible en français
PROTECTED B (when completed)
Social Insurance Number:
8A. Did the deceased ever receive or
Régime de rentes du Québec?
Canada Pension Plan?
Old Age Security?
(Quebec Pension Plan)
apply for a benefit under the:
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.
The Estate of
FOR OFFICE
USE ONLY
First Name and Initial
Last Name
11. Optional
Mr.
Mrs.
Ms.
Miss
Mailing Address (No., Street, Apt., P.O. Box, R.R.)
City, Town or Village
Province or Territory
Country other than Canada
Postal Code
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. Optional
First Name and Initial
Last Name
Mr.
Mrs.
Ms.
Miss
14. Relationship of applicant to the deceased
Written Communications
Verbal Communications
Your
(Check one)
(Check one)
Language
Preference
English
French
English
French
For the Estate of
FOR OFFICE
USE ONLY
Mailing Address (No., Street, Apt., P.O. Box, R.R.)
City, Town or Village
Province or Territory
Country other than Canada
Postal Code
SC ISP-1200 (2018-12-19) E
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PROTECTED B (when completed)
Social Insurance Number:
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 signature
Date
(YYYY-MM-DD)
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 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 the applicant
Address (No., Street, Apt., P.O. Box, R.R.)
City, Town or Village
Province or Territory
Country other than Canada
Postal Code
Telephone number during the day
Witness's signature
Date
(YYYY-MM-DD)
FOR OFFICE USE ONLY
Application taken by: (Please print name and phone number)
Telephone Number
Application approved pursuant to the Canada Pension Plan.
Authorized Signature
Date
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PROTECTED B (when completed)
Social Insurance Number:
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.
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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: 613-957-1954 (we accept collect calls)
TTY: 1-800-255-4786
Important: Please have your social insurance number ready when you call.
NEWFOUNDLAND AND LABRADOR
ONTARIO
Service Canada
For postal codes beginning with "K or P"
PO Box 9430 Station A
Service Canada
St. John's NL
A1A 2Y5
PO Box 2013 Station Main
CANADA
Timmins ON
P4N 8C8
CANADA
PRINCE EDWARD ISLAND
Service Canada
MANITOBA AND SASKATCHEWAN
PO Box 8000 Station Central
Service Canada
Charlottetown PE
C1A 8K1
PO Box 818 Station Main
CANADA
Winnipeg MB
R3C 2N4
CANADA
NOVA SCOTIA
Service Canada
ALBERTA / NORTHWEST TERRITORIES
PO Box 1687 Station Central
AND NUNAVUT
Halifax NS
B3J 3J4
Service Canada
CANADA
PO Box 818 Station Main
Winnipeg MB
R3C 2N4
CANADA
NEW BRUNSWICK AND QUEBEC
Service Canada
PO Box 250
BRITISH COLUMBIA AND YUKON
Fredericton NB
E3B 4Z6
Service Canada
CANADA
PO Box 1177 Station CSC
Victoria BC
V8W 2V2
CANADA
ONTARIO
For postal codes beginning with "L, M or N"
Service Canada
PO Box 5100 Station D
Scarborough ON
M1R 5C8
CANADA
Disponible en français
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