Child Rearing Provision Canada Pension Plan
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1
2
3Service
PROTECTED B (when completed)
Canada
Personal Information Banks
ESDC PPU 140, 146 and 175
Child Rearing Provision
Canada Pension Plan
If you are applying for the Child Rearing Provision on your behalf, please provide your Social Insurance Number and
name in number 1 and 2 below. If you are applying on behalf of a person who is deceased, please provide the Social
Insurance Number and name of the deceased in number 1 and 2 below.
1. Social Insurance Number
2.
First name, initial and last name
Mr.
Mrs.
Ms.
Miss
3. Information about the children
List all children born after December 31, 1958.
If the child was born outside
Canada, tell us the date the
Child's Full Name
Child's SlN
Child's Date of Birth
child entered Canada
YYYY-MM-DD
YYYY-MM-DD
a)
b)
c)
d)
Should you need to list more children, use a separate sheet, answer the questions for each additional child, sign
the sheet, indicate your (or the deceased's) Social Insurance Number and attach the sheet to this form.
Were you the primary caregiver for these children from birth until age 7?
Yes
No
If no, please list any periods of time where you were not the primary caregiver and provide a reason:
From:
To:
From:
To:
(YYYY-MM)
(YYYY-MM)
(YYYY-MM)
(YYYY-MM)
Reason:
Reason:
Did you or your spouse or common-law partner receive Family Allowances or
Yes
No
Canada Child Tax Benefits for these children?
If yes, please indicate who received the benefits:
You
Your spouse or common-law partner
List any periods of time while the children were under the age of seven and when you did not receive Family
Allowances or Canada Child Tax Benefits and provide a reason. Do not list periods of time when you were eligible
for the Canada Child Tax Benefit, but did not receive it because your family income was too high.
From:
To:
From:
To:
(YYYY-MM)
(YYYY-MM)
(YYYY-MM)
(YYYY-MM)
Reason:
Reason:
Note: If you did not provide a Social Insurance Number for each child, or if any of the children were
born abroad, please refer to the Information sheet under section "Documents required".
Service Canada delivers Employment and Social Development Canada
programs and services for the Government of Canada
SC ISP-1640 (2016-08-30) E
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