Residential Loan Application For Reverse Mortgages Page 4
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5PROTECTED B (when completed)
SIN
(Refer to Section 8 of the information sheet to help you complete this section.)
8. I would like an estimate of my Canada Pension Plan (CPP) Post-Retirement Benefit.
If I work or plan to return to work while receiving my CPP retirement pension.
When I am aged 60 to 65 years old.
(Contributions to the CPP Post-Retirement Benefit are mandatory for you and your employer if you are working while
receiving your CPP retirement pension.)
What will my estimated Post-Retirement Benefit be based on my
Estimated annual
In year
estimated annual earnings?
earnings
$
Estimate 1
Estimate 2
$
Estimate 3
$
When I am aged 65 to 70 years old.
(You and your employer continue to make CPP contributions unless you choose not to contribute. The choice to make
contributions or not can only be made once per calendar year. At age 70, you will stop contributing.)
Note: Estimated earnings (For each estimate requested below, enter the amount of your estimated earnings based on
one or any combination of these scenarios. Only one scenario can apply to each estimate.)
- Estimated annual earnings for the year where you work and contribute all year, OR
- Estimated earnings in that year for the period up to the month you plan to stop contributing, OR
- Estimated earnings in that year for the period after the month you plan to start contributing again.
If you do not plan to contribute all year
What will my estimated Post-
I plan
Estimated earnings
Month I plan to
Month I plan to start
Retirement Benefit be based
In year
to contribute
or
(see note above)
stop contributing
contributing again
on my estimated earnings?
all year
Estimate 1
$
Yes
No
Estimate 2
$
Yes
No
Estimate 3
$
Yes
No
Privacy Notice Statement
The information you provide is collected under the authority of the Canada Pension Plan legislation and will be used to
estimate the amount of your Canada Pension Plan (CPP) Retirement benefit and Post-Retirement Benefit. This is not
an application for a CPP benefit. The Social Insurance Number (SIN) is collected under the authority of section 52 of
the Canada Pension Plan Regulations, and in accordance with Treasury Board Secretariat Directive on the SIN as an
authorized user of the SIN. The SIN will be used to ensure an individual's exact identification so that contributory
earnings can be correctly posted allowing for benefits and entitlements to be accurately calculated.
Submitting this request for an estimate is voluntary. However, if you refuse to provide your personal information, the
Department of Employment and Social Development Canada (ESDC) will be unable to provide you with an estimate of
your CPP Retirement benefit.
The information you provide may be used and/or disclosed for policy analysis, research and/or evaluation purposes. In
order to conduct these activities, various sources of information under the custody and control of ESDC may be linked.
However, these additional uses and/or disclosures of your personal information will never result in an administrative
decision being made about you (such as a decision on your entitlement to a benefit).
Your personal information is administered in accordance with the Department of Employment and Social Development
Act, Canada Pension Plan and the Privacy Act. You have the right of access to, and to the protection of, your personal
information. It will be kept in Personal Information Bank ESDC PPU 146. Instructions for obtaining this information are
outlined in the government publication entitled Info Source, which is available at the following Web site address:
infosource.gc.ca. Info Source may also be accessed online at any Service Canada Centre.
Signature
Date
(YYYY-MM-DD)
X
SC ISP-1003 (2014-03-03) E
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