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Number ISP1618C
Title Request to Deduct and Pay a One-time Retroactive Payment to an Insurer
Purpose This form is for use by long-term disability insurance companies who have a valid Approval Deduction and Payment Agreement with the Minister of Human Resources and Social Development Canada and who are seeking a reimbursement from Service Canada for CPP Disability benefits paid to you while you were receiving benefits from your insurer for the same period. This form contains a statutory declaration which requires the insurer to declare that they are acting in accordance with the terms and conditions of the Approval Deduction and Payment Agreement.
GroupCanada Pension Plan
Important Information
Returning the Form

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Income Security Programs

Request to Deduct and Pay a One-time Retroactive Payment to an Insurer
PDF: ISP-1618(C), 165 KB, printed on 3 pages (8.5x11)

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