Fillable Social Insurance Number Application (Page 2 of 2) in pdf

Government

Gouvernement

of Canada

du Canada

INSTRUCTION SHEET

A -

Complete the application form.

You must provide an original primary document according to your status in Canada. Refer to leaflet "Documents you need to apply for a Social

B -

Insurance Number (SIN) " (IN-105).

C -

If the name on your primary document is different from the name you are now using, you must also submit an original supporting document. Refer

to leaflet "Documents you need to apply for a Social Insurance Number (SIN)" (IN-105).

D -

If you are replacing your SIN card, you must pay a $10.00 fee (subject to change). Make your personal cheque, bank draft or money order

payable in Canadian funds to the RECEIVER GENERAL FOR CANADA. You may pay in cash at a Human Resource Centre of Canada. DO NOT

MAIL CASH.

E -

If you are a guardian, you must submit an original document showing proof of legal guardianship in order to sign an application form on behalf of

the applicant.

The information contained in the vital statistics registers and the Citizenship and Immigration Canada records can be used to validate information

that you provide with this application form when presenting a document orginating from these sources.

If you are employed, it is important that the name and Social Insurance Number under which you are working are identical to the name

and Social Insurance Number that appear on your card. This will ensure that your Canada Pension Plan and/or Quebec Pension Plan

contributions are properly credited to you.

TO APPLY IN PERSON

We encourage you to take your application and original document(s) to the nearest Human Resource Centre of Canada. Your application will be

certified and your document(s) will be returned to you immediately.

TO APPLY BY MAIL

If it is not convenient for you to apply in person, you may mail your application and original document(s) required, and fee if applicable, to the address

below. Your document(s) will be returned with your card. PLEASE NOTE THAT WE ARE NOT ACCOUNTABLE FOR DOCUMENTS LOST IN

TRANSIT.

Social Insurance Registration

If your application is in order, you should receive your Social Insurance

P.O. Box 7000

Number card in approximately three weeks. If you do not receive your SIN

BATHURST NB E2A 4T1

card within this period, please call 1 800 206-7218.

FOR MORE INFORMATION

Visit the Social Development Canada Web site at or dial toll-free 1 800 206-7218.

For general enquiries, you can also contact us by e-mail at sin-nas@sdc-dsc.gc.ca

DETACH HERE

DO NOT WRITE BELOW - FOR LOCAL OFFICE USE ONLY

PROTECTED WHEN COMPLETED - A

ACKNOWLEDGMENT OF APPLICATION

Government

Gouvernement

of Canada

du Canada

FOR A SOCIAL INSURANCE NUMBER

The Employment Insurance Act requires a person to apply for a Social Insurance Number and to produce his/her Social Insurance Number card to

his/her employer within three (3) days after having received it. However, the legislation does not prevent persons from working in insurable

employment prior to being issued a Social Insurance Number and card.

Accordingly, this acknowledges that

HRCC STAMP

(DO NOT use SIN Certification Stamp)

has applied for a first Social Insurance Number.

has applied for a replacement card.

has applied to change the expiry date.

Social Insurance Number

Initials

Date

When the application is approved, the Social Insurance Number card will be sent to the

address specified by the applicant at the time of application.

NAS-2120-(05-04)

(Internet version)

Social Insurance Number Application Page 2

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