[ Forms Catalogue ] [ Forms List ] [ Help ]

Form Detail

Details
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
Important Information
Returning the Form

Forms
This site uses PDF form technology. To print these high-quality PDF forms, you must have a PDF reader installed. If you do not already have such a reader, there are several available on the Internet : Adobe Reader and Foxit Reader The form(s) are available in the following formats.
Income Security Programs

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

For more information, please consult the Forms Help page.

Date modified: