|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.|
|Group||Canada Pension Plan|
Returning the Form
|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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