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How to Appeal

Proactive Disclosure

Notice of Appeal

[PDF version 133 kB]

You may use this form to appeal a decision made by HRSDC 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.

1a)	Appellant Information:
	Your Name:
	Social Insurance Number (SIN):
	Address:
	Apt, Street No, Street:
	City:
	Province:
	Country:
	Postal Code:
	Telephone Number:
	Fax Number (if applicable):
	E-mail (if applicable):

1b)

If this appeal involves a survivor's benefit (survivor, death, orphan) please provide the following information regarding the deceased contributor.

Name of the Deceased Contributor:
Your Relationship with the Deceased Contributor:
Social Insurance Number (SIN):

In which official language would you like your Review Tribunal hearing to be held?

English: French:

3a)

Please indicate the date that you received your decision letter from the Department of Human Resources and Skills Development Canada.

	(yyyy-mm-dd)
Date:

3b)

Please provide your reasons for appealing the decision of the Department of Human Resources and Skills Development Canada in the space below. (If you require more space, please write on additional blank sheets of paper and attach to this form.)

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 Human Resources and Skills Development Canada.

If you are over the 90 day appeal period in appealing the Reconsideration decision, please provide a full explanation of the reasons why you are late.

________________________________	_____________________
Signature	Date

Please return this form to:
Office of the Commissioner of Review Tribunals
Canada Pension Plan/Old Age Security
P.O. Box 8250, Station "T"
Ottawa, ON K1G 5S5