ESDC EMP5608 (2015-01-001) E
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PROTECTED WHEN COMPLETED - B
Emploi et
Développement social Canada
Employment and
Social Development Canada
(Personal Information bank: PPU 038)
APPLICATION FOR: Canada Disability Savings Grant and/or Canada Disability Savings Bond
Instructions:
1. This form is to be completed by the holder of the Registered Disability Savings Plan (RDSP).
2. Read this document carefully. If you have any questions, do not hesitate to ask the RDSP issuer.
3. This form is valid only if completed, signed, dated and given to the RDSP issuer. Do NOT send directly to Employment and Social Development
Canada (ESDC).
4. Keep a copy for your records.
RDSP Issuer RDSP Contract No.
1 Information About the Beneficiary
Beneficiary
The beneficiary is the
person who will receive
the funds in the RDSP
in the future.
Complete the following information about the beneficiary of the RDSP.
The name must be entered exactly as it appears on Social Insurance Number documentation
Beneficiary's Last Name Beneficiary's First Name Beneficiary's Middle Name
Date of Birth Social Insurance Number
2 Information About the Holder
Holder
You are the holder
if you opened the RDSP.
or
The agency is a holder
in the case where the
beneficiary is a “child
in care”.
Complete the following information only if the holder is different from the beneficiary of the RDSP.
The name must be entered exactly as it appears on Social Insurance Number documentation.
If there is more than one holder, please complete Annex A for each of the other holders.
Holder's Last Name
Holder's First Name
Holder's Middle Name
Name of Agency Name of Agency Representative
Social Insurance Number / Business Number (if an Agency) Total Number of Holders
3 Declaration of Refusal
Complete this section only if you DO NOT want to apply for either the grant or bond.
Check the box for the payment you DO NOT wish to apply for.
You are not required to
receive grants or bonds
as part of the RDSP.
I DO NOT wish to request payment of the:
Canada Disability Savings Grant (grant) Canada Disability Savings Bond (bond)
4 Declaration and Consent of the Holder
The holder must read
this section and sign
to receive grants and
bonds in the RDSP.
If the holder is also a
primary caregiver,
complete Annex B.
I authorize the RDSP issuer to apply for the grant and/or bond.
I confirm that the beneficiary meets all eligibility criteria identified in Section 6.1.
I understand that the provision of the information on this form is voluntary and that I am not required to give my consent;
however, if I do not give my consent, the Government of Canada cannot pay the grant and/or bond.
I confirm that I have read, understood, and received a copy of this document, including the privacy rights found in Section 7,
and I consent to the use and sharing of my personal information as outlined.
Date (yyyy-mm-dd)
Holder's Signature
5 Declaration and Consent of the Beneficiary
The beneficiary must
read this section and
sign to receive grants
and bonds in the RDSP.
Complete this section if the beneficiary is of the age of majority.
This section must also be completed and added to the issuer’s records once the beneficiary turns 18 years of age if
the beneficiary has not previously provided consent.
I confirm that I meet all eligibility criteria identified in Section 6.1.
I understand that the provision of the information is voluntary and that I am not required to give my consent; however, if I do not
give my consent, the Government of Canada cannot pay the grant and/or bond.
I confirm that I have read, understood, and received a copy of this document, including the privacy rights found in Section 7,
and I consent to the use and sharing of my personal information as outlined.
Date (yyyy-mm-dd)
Beneficiary’s Signature
Where to get more information about the Canada Disability Savings Grant and Canada Disability Savings Bond:
Phone: 1 800 O Canada (1 800 622-6232); 1-800-926-9105 (TTY)
E-mail: rdsp-reei@hrsdc-rhdcc.gc.ca Internet:
www.disabilitysavings.gc.ca
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Mackenzie Investments
ESDC EMP5608 (2015-01-001) E
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RDSP Contract No.
6 Conditions for Payment of the Grant and/or Bond
This section explains
some important
conditions under which
the grants and bonds
may be paid into an
RDSP.
For more information
please refer to the
Canada Disability
Savings Act and the
Income Tax Act.
1. The beneficiary must be eligible to receive the Disability Tax Credit (DTC) and be resident in Canada in the year in
which the contribution to the RDSP is made (or, if applicable, the year to which the contribution is allocated) and in
the year (or years) to which a bond is payable, as well as immediately before the bond is paid.
2. In order for the grant or bond to be paid, an application must be made on or before December 31 of the year
the beneficiary turns age 49. In addition, for the grant, contributions must also be made on or before this date
3. The total of all contributions and ‘rollover’ amounts deposited to the RDSP of a beneficiary must not exceed
$200,000.
4. Not more than $70,000 in grants and $20,000 in bonds may be paid into the RDSP of a beneficiary during his or her
lifetime.
5. The amount of grant and bond entitlement for a given year depends on the beneficiary’s family income of the second
preceding tax year (for example, 2014 amounts are based on 2012 family income).
6. A beneficiary can be paid unused grant and bond entitlements from the past 10 years (starting from 2008 when the
RDSP became available) – if he/she met all eligibility criteria during those previous years. An application and a
contribution (if applicable) must be made on or before December 31 of the year the beneficiary turns age 49. The
matching rate for grants will be the same rate that would have applied if the contribution had been made in the
year in which the grant entitlement was earned. The amount of unused grant and bond entitlements depends on
the family income established for the particular year that the unused entitlement was earned.
7. Grants and bonds can be paid on unused entitlements up to an annual maximum of $10,500 for grant and $11,000
for bond.
7 Payment of the Grant and/or Bond
The application for the grant will be submitted in ESDC’s electronic system by the issuer at the time of each
contribution. A new application form is not required for each contribution.
The application for the bond will be automatically resubmitted in ESDC’s electronic system every year by the issuer.
A new application form is not required for each year.
Unused entitlement to grant and bond for the last ten years (starting in 2008) will be calculated automatically, with
contributions allocated to highest then oldest matching rates that the beneficiary is entitled to.
This section clarifies
some of the
administrative processes
around the payment of
the grant and bond.
Up to and including the year that the beneficiary turns 18 years of age, the family income used to determine the
annual grant and bond entitlement is based on the family income of the primary caregiver (unless the beneficiary is
under the care of a public department, agency, or institution that is legally authorized to act on behalf of the
beneficiary and where the organization receives at least one payment in respect of the beneficiary under the Child
Special Allowances Act).
Consent to use, share, and disclose the personal information of the primary caregivers is required in order to
determine the amount of grant and bond for each year that the entitlement was generated. Annex B provides
additional details and will need to be completed to ensure that the information for the years up to when the
beneficiary turns 18 is available to determine the amount of grant and bond.
Starting in the year that the beneficiary turns 19 years of age and each year after this, personal information of the
beneficiary held by the Canada Revenue Agency is used to verify family income. This is true regardless of whether
he or she resides with or continues to receive support from their parents or guardians.
Should the plan holder ever wish to discontinue payments of the grant and/or bond into the beneficiary’s RDSP, the
‘Revocation of Request for Canada Disability Savings Grant and/or Canada Disability Savings Bond’ form available
at the issuer’s place of business must be completed, signed, and given to the issuer.
8 Your Privacy Rights
This section explains
why your information is
collected and how it is
used, shared and
protected. It also
explains how you can
access your personal
information.
The information you provide on this form is collected under the authority of the Canada Disability Savings Act
(CDSA) and the Income Tax Act (ITA) for the purposes of determining eligibility for a Canada Disability Savings
Grant (grant) or Canada Disability Savings Bond (bond), (including for previous years in order to determine if there
are any unused grant and/or bond entitlements from those years), to calculate amounts payable and to administer
the grant and bond. Information may be used by and shared between Employment and Social Development Canada
(ESDC), the Canada Revenue Agency, and the issuer for the administration of the CDSA and the ITA.
The Social Insurance Number (SIN) is collected under the authority of the CDSA and Income Tax Act, and will be
used as a file identifier and to ensure an individual’s exact identification so that the beneficiary’s eligibility for the
Disability Tax Credit (DTC), residency and family income can be verified for the purposes of determining whether a
grant or bond may be paid. While eligibility for the DTC may be verified, information contained within the Disability
Tax Credit Certificate (i.e., the nature of the beneficiary's disability) will not be collected, used or disclosed.
Submitting this application is voluntary. However, if you refuse to provide your personal information, ESDC will be
unable to process your application.
The information you provide may also be used and/or disclosed by ESDC for policy analysis, research and/or
evaluation purposes of RDSP, grant and/or bond administration and/or design. In order to conduct these activities,
various sources of information under the custody and control of ESDC may be linked. However, these additional
uses and/or disclosures of your personal information will never result in an administrative decision being made
about you (such as a decision on your entitlement to a grant and/or bond).
Your personal information is administered in accordance with the CDSA, the Department of Employment and Social
Development Act, the Privacy Act, the Income Tax Act and all other applicable laws. You have the right to access or
request correction to your personal information kept in Personal Information Bank “HRSDC PPU 038”. Instructions
for obtaining this information are outlined in the government publication entitled Info Source, which is available at
the following Web site address: www.infosource.gc.ca. Info Source may also be accessed online at any Service
Canada Centre.
Personal information of the plan holder is used to verify their identity in the Social Insurance Registry in order to
identify the correct RDSP.
Personal information of the beneficiary is used to verify their identity in the records held in the Social Insurance
Registry in order to identify the correct RDSP. Where the beneficiary is not of the age of the majority, the holder
authorizes the collection, use, and sharing of the beneficiary’s personal information for this purpose.
Starting in the year that the beneficiary turns 19 years of age and each year after this, their personal information
held by the Canada Revenue Agency is used to verify family income as well as validate eligibility criteria. The
beneficiary’s consent to use, share and disclose their personal information is voluntary but if they do not consent,
the Government of Canada cannot pay bond starting in the year the beneficiary turns 19 years of age and the
maximum matching rate for grant will be 100% of contributions up to $1,000 each year.
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ESDC EMP5608 (2015-01-001) E
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RDSP Contract No.
9 Definitions
These definitions are
provided for your
information only and do
not constitute the legal
definitions. In the event
of a discrepancy, the
legal definitions found in
the Canada Disability
Savings Act, and the
Income Tax Act prevail.
Beneficiary: The individual who will receive payments from the RDSP in the future.
Disability Tax Credit (DTC): A non-refundable tax credit available to individuals who, in a given taxation year, have
one or more severe and prolonged impairments in physical or mental functions. A medical practitioner, using the
appropriate form, must certify the effects of the impairment and the Canada Revenue Agency must approve the
application. See the Income Tax Act, section 118.3 for further details.
Issuer: A corporation authorized to offer the RDSP to the public. The issuer opens an RDSP for the holder and
handles related administrative matters.
Holder: is an individual, agency, department or institution that opens an RDSP, names one beneficiary and may
authorize or make deposits (contributions) on behalf of the beneficiary into the RDSP. The plan holder may be:
The beneficiary;
If the beneficiary is not of the age of majority at the time the RDSP is opened, the legal parent, legal representative,
or public department, agency, or institution that is legally authorized to act on behalf of the beneficiary;
If the beneficiary is of the age of majority at the time the RDSP is opened but is not contractually competent, the legal
representative or the public department, agency, or institution that is legally authorized to act on behalf of the
beneficiary; or
If the RDSP is opened before 2017 and the beneficiary is of the age of majority at the time the RDSP is opened but the
issuer, after a reasonable enquiry, has doubts regarding the beneficiary’s contractual competency and no person or
entity has been legally authorized to act on their behalf: the spouse, common-law partner or parent of the beneficiary
(also referred to as a qualifying family member (see s. 146.4(1) Income Tax Act for further details)).
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This form is available in alternate formats
AP1040 10/15
01982