Form Sc Isp-1151 - Application For Disability Benefits Page 3
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Social Insurance Number
11. Do you have children under the age of 18, in the custody and control of someone else?
Yes
If yes, provide the following information:
No
First Child's First Name and Initial
Last Name
FOR OFFICE USE ONLY
Custodian's Full Name
Address (No., Street, Apt., or R.R.)
City
Province or Territory
Country (If other than Canada)
Postal Code
Second Child's First Name and Initial
Last Name
FOR OFFICE USE ONLY
Custodian's Full Name
Address (No., Street, Apt., or R.R.)
City
Province or Territory
Country (If other than Canada)
Postal Code
CHILDREN OVER THE AGE OF 18
12. Do you have children between the ages of 18 and 25 attending school, college or university now or within the
past 11 months?
Yes
No
If yes, provide the following information:
First Child's First Name and Initial
Last Name
FOR OFFICE USE ONLY
Address (No., Street, Apt., R.R.)
City
Province or Territory
Country other than Canada
Postal Code
Date of Birth
YYYY-MM-DD
Second Child's First Name and Initial
Last Name
FOR OFFICE USE ONLY
Address (No., Street, Apt., R.R.)
City
Province or Territory
Country other than Canada
Postal Code
Date of Birth
YYYY-MM-DD
IF THERE IS INSUFFICIENT SPACE TO LIST ALL OF YOUR CHILDREN, USE A SEPARATE SHEET, NOTATE YOUR SOCIAL
INSURANCE NUMBER, SIGN IT AND ATTACH IT TO THIS APPLICATION.
13. On behalf of any of the children listed in this application, has an application previously been made, or have benefits
been received from:
Applied
Received
Yes
No
Unknown
Yes
No
Unknown
CANADA PENSION PLAN
Yes
No
Unknown
Yes
No
Unknown
QUEBEC PENSION PLAN
Social Insurance Number
Social Insurance Number
If yes, indicate under which Social
Insurance Number(s).
SC ISP-1151 (2015-02-23) E
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Parent category: Legal