// open printable form
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new_win.document.write("OCRT - Notice of Appeal - Office of the Commissioner of Review Tribunals<\/title>\n");
new_win.document.write("<link rel='StyleSheet' href='/css/base.css' type='text/css'>\n");
new_win.document.write("<link rel='StyleSheet' href='/css/base-institution.css' type='text/css'>\n");
new_win.document.write("<link rel='StyleSheet' href='/css/institution.css' type='text/css'>\n");
new_win.document.write("<\/head>\n");
new_win.document.write("<body>\n");
new_win.document.write("<table align='center' width='600' border='0' cellpadding='0' cellspacing='0'>\n");
new_win.document.write("<tr><td width='600'>\n");
new_win.document.write("<table border='0' cellpadding='3' cellspacing='0' width='600'>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td width='600' valign='top' colspan='3'>\n");
new_win.document.write("<table border='0' cellpadding='0' cellspacing='0' width='100%'>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td><img src='/images/sig-eng.gif' width='372' height='50' border='0' alt='Office of the Commissioner of Review Tribunals - Bureau du Commissaire des tribunaux de révision'><\/td>\n");
new_win.document.write("<td align='right' valign='bottom' style='padding-bottom:8px;'><img border='0' src='/images/wm.gif' width='83' height='20' alt='Symbol of the Government of Canada'><\/td>\n");
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// new_win.document.write("<h1 align='center'>Office of the Commissioner of Review Tribunals (OCRT) CPP/OAS<\/h1>\n");
// new_win.document.write("<p>\n");
new_win.document.write("<h2 align='center'>Notice of Appeal<\/h2>\n");
new_win.document.write("<table border=0 cellspacing=0 cellpadding=0 bgcolor='white'>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td colspan=2><p>You may use this form to appeal a decision made by Social Development Canada about CPP or OAS benefits. After we receive your completed form at the OCRT, we will send you an acknowledgment letter and one of our Client Service Officers will contact you.<br><br><\/p><br><\/td>\n");
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new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>1a) <\/p><\/td>\n");
new_win.document.write("<td>\n");
new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td colspan=2 valign='top'><p>Appellant Information:<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>Your Name:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtName.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>Social Insurance Number (SIN):<\/p><\/td> \n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtSin.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>Address: <\/p><\/td>\n");
// new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtAddress.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td align='right'><p>Apt, Street No, Street: <\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtAddress.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td align='right'><p>City:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtCity.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td align='right'><p>Province:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtProvince.value + "<\/p><\/td>\n");
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new_win.document.write(" <tr>\n");
new_win.document.write(" <td align='right'><p>Country:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtCountry.value + "<\/p><\/td>\n");
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new_win.document.write(" <tr>\n");
new_win.document.write(" <td align='right'><p>Postal Code:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtPostalCode.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>Telephone Number:<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>(" + document.frmApp.txtTelephoneAreaCode.value + ") " + document.frmApp.txtTelephone.value + "<\/p><\/td>\n");
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new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>Fax Number (if applicable):<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>(" + document.frmApp.txtFaxAreaCode.value + ") " + document.frmApp.txtFax.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr> \n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p>E-mail (if applicable):<\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtEmail.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr> \n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>1b) <\/p><\/td>\n");
new_win.document.write("<td>\n");
new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td colspan=2 valign='top'><p>If this appeal involves a survivor's benefit (survivor, death, orphan), please provide the following information regarding the deceased contributor. \n");
new_win.document.write(" <\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td width='50%' nowrap><p>Name of the Deceased Contributor: <\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtNameDeceasedContributor.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td width='50%' nowrap><p>Your Relationship with the Deceased Contributor: <\/p><\/td>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtRelationshipWithDeceased.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td width='50%' nowrap><p>Social Insurance Number (SIN):<\/p><\/td> \n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtDeceasedSin.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>2) <\/p><\/td>\n");
new_win.document.write("<td>\n");
new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td colspan=2 valign='top'><p>In which official language would you like your Review Tribunal hearing to be held? \n");
new_win.document.write(" <\/p><p>");
new_win.document.write(" " + langChoiceStr + " ");
new_win.document.write(" <\/p><\/td>\n");
new_win.document.write(" <\/tr> \n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
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new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>3a) <\/p><\/td>\n");
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new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td COLSPAN=2 valign='top'><p>Please indicate the date that you received your decision letter from Social Development Canada. \n");
new_win.document.write(" <\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td width='10%'><p>Date:<\/p><\/td> \n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.txtDateRecvLetter.value + "<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>3b) <\/p><\/td>\n");
new_win.document.write("<td>\n");
new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td COLSPAN=2 valign='top'><p>Please provide your reasons for appealing the decision of the Department of Social Development Canada in the space below. If you require more space, please write on additional blank sheets of paper and attach to this form.)<\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.taAppealreason.value + " <\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<tr>\n");
new_win.document.write("<td valign='top'><p>4) <\/p><\/td>\n");
new_win.document.write("<td>\n");
new_win.document.write(" <table cellpadding='4' cellspacing='0'>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td COLSPAN=2 valign='top'><p>An appeal to the Office of the Commissioner of Review Tribunals must be sent within 90 days of receiving the decision letter from the Department of Social Development Canada.\n");
new_win.document.write("If you are appealing more than 90 days after receiving the decision letter, please provide detailed reasons as to why you are late in appealing: <\/p><\/td>\n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <tr>\n");
new_win.document.write(" <td><p class='frm-prndata'>" + document.frmApp.taAppealLateReason.value + "<\/p><\/td> \n");
new_win.document.write(" <\/tr>\n");
new_win.document.write(" <\/table>\n");
new_win.document.write(" <br>\n");
new_win.document.write("<\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<tr><td colspan=2>\n");
new_win.document.write("<table width='100%'>\n");
new_win.document.write("<tr>\n");
new_win.document.write(" <td valign='top' align='left'>\n");
new_win.document.write(" <p>________________________________\n");
new_win.document.write("<br> <b>Signature<\/b><\/p>\n");
new_win.document.write(" <\/td>\n");
new_win.document.write(" <td valign='top' align='right'>\n");
new_win.document.write(" <p>_____________________\n");
new_win.document.write("\n");
new_win.document.write("<br><b>Date<\/b><\/p>\n");
new_win.document.write(" <\/td>\n");
new_win.document.write("<\/tr>\n");
new_win.document.write("<\/table>\n");
new_win.document.write("<p><em><strong>Please return this form to:<\/strong><\/em><br>Office of the Commissioner of Review Tribunals <br>Canada Pension Plan\/Old Age Security <br>P.O. Box 8250, Station "T"<br>Ottawa, ON K1G 5S5 <\/p>");
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