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Number ISP1618A
Title Irrevocable Consent to Deduct and Pay an Insurer
Purpose This form is used by persons applying for a Canada Pension Plan Disability benefit who are in receipt of monthly disability benefits from their private insurer. If you are granted a CPP Disability benefit, this form gives Service Canada permission to reimburse your insurer a one-time payment which covers the period of time you were entitled to both long-term disability insurance benefits and CPP Disability benefits. This form eliminates a payment you would otherwise owe to your insurer. NOTE: This consent is "irrevocable". Once signed, the consent cannot be cancelled at any time.
GroupCanada Pension Plan
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Income Security Programs

Irrevocable Consent to Deduct and Pay an Insurer
PDF: ISP-1618(A), 197 KB, printed on 5 pages (8.5x11)

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