Disclaimer: This application form has been developed by external sources in cooperation with Employment and Social Development Canada. The content and

Canada / Korea Agreement Applying for a Korean Old Age and/or Disability and/or Survivor Pension and/or Lump Sum Payment Here is some important information you need to consider when completing your application. Please ensure you sign the application. If you are signing with a mark, (for example: X ) the signature of a witness is required. Your application must be supported by documentation. Please submit the documents requested. Failure to complete the application and provide the requested documentation may result in delays in processing your application. Where original documents are specifically requested, originals must be submitted with your application. You should keep a certified true copy of any originals you send us for your records. Some countries require original documentation which will not be returned to you. You may submit the original or a photocopy that is certified as true for any of the documents where originals are not required. It is better to send certified copies of documents rather than originals. If you choose to send original documents, send them by registered mail. We will return the original documents to you. We can only accept a photocopy of an original document if it is legible and if it is a certified true copy of the original. Our staff at any Service Canada centre will photocopy your documents and certify them free of charge. If you cannot visit a Service Canada Centre, you can ask one of the following people to certify your photocopy: Accountant; Chief of First Nations Band; Employee of a Service Canada Centre acting in an official capacity; Funeral Director; Justice of the Peace; Lawyer, Magistrate, Notary; Manager of Financial Institution; Medical and Health Practitioners: Chiropractor, Dentist, Doctor, Pharmacist, Psychologist, Nurse Practitioner, Registered Nurse; Member of Parliament or their staff; Member of Provincial Legislature or their staff; Minister of Religion; Municipal Clerk; Official of a federal government department or provincial government department, or one of its agencies; Official of an Embassy, Consulate or High Commission; Officials of a country with which Canada has a reciprocal social security agreement; Police Officer; Postmaster; Professional Engineer; Social Worker; Teacher. People who certify photocopies must compare the original document to the photocopy, state their official position or title, sign and print their name, give their telephone number and indicate the date they certified the document. They must also write the following statement on the photocopy: This photocopy is a true copy of the original document which has not been altered in any way. If a document has information on both sides, both sides must be copied and certified. You cannot certify photocopies of your own documents, and you cannot ask a relative to do it for you. Return your completed application, forms and supporting documents to: International Operations Service Canada P.O. Box 250 Fredericton, NB E3B 4Z6 CANADA

Disclaimer: This application form has been developed by external sources in cooperation with Employment and Social Development Canada. The content and language contained in the form respond to the legislative needs of those external sources.

한국국민연금관리공단 Korean National Pension Service CAN-KOR 1 대한민국과캐나다간사회보장협정에의한한국급여청구서 APPLICATION FOR KOREAN BENEFITS UNDER THE AGREEMENT ON SOCIAL SECURITY BETWEEN THE REPUBLIC OF KOREA AND CANADA * 해당질문에정확히기재하십시오. / Please complete the relevant sections. * 해당증빙자료를첨부하십시오. / Please attach any relevant supporting documentation. A. 일반정보 / GENERAL INFORMATION 1. 청구급여를표시하십시오. / Please mark with an (x) the type of benefit for which you are applying. 노령연금 / Old Age Pension 장애연금 / Disability Pension 유족연금 / Survivor Pension 분할연금 / Divided Pension 일시금 / Lump Sum Benefit 2. 가입자에관한정보 / Information about the contributor a) 성명 / Full name c) 출생시성명 / Name at birth e) 한국국민연금번호또는주민 / 외국인등록번호 / Korean National Pension Number or Resident (Alien) Registration Number f) 캐나다사회보험번호 / Canadian Social Insurance Number g) 출생지 / Place of birth i) 주소 / Address 이름 /First Middle 성 /Last b) 성별 /Sex 남 / Male 여 / Female d) 생년월일 /Date of birth 월 /M 일 /D 연 /Y h) 국적 / Nationality ( 우편번호 / Postal code) j) 전화번호 / Telephone number k) 전자우편주소 / E-mail address 3. 수급권자에관한정보 (2 번의가입자가아닌경우에만기재하십시오 ) / Information about the beneficiary (Please fill in only if the beneficiary is not the same as the above-named contributor.) a) 성명 / Full name b) 생년월일 / Date of birth d) 가입자와의관계 / Relationship to contributor e) 주소 / Address 이름 / First Middle 성 / Last 월 / M 일 / D 연 / Y 남 / Male c) 성별 / Sex 여 / Female ( 우편번호 / Postal code) f) 전화번호 / Telephone number g) 전자우편주소 / E-mail address

h) 미성년자의법정대리인성명 / If minor, name of his/her legal agent/ representative 이름 / First Middle 성 / Last i) 법정대리인서명 / Signature of legal agent/ representative 4. 가입자의피부양자에관한정보 /Information about dependents supported by the contributor a) 배우자 ( 사실혼포함 ), 18 세미만또는중증장애인자녀 ( 양자녀포함 ), 60 세이상또는중증장애인부모 ( 배우자부모포함 ) / Spouse (including common-law), children under age 18 or severely disabled (including legally adopted), parents over age 60 or severely disabled (including spouse s parents) * 추가여백이필요한경우별지를사용하십시오. / Please use a separate sheet, if necessary. 장애여부 / 생년월일 ( 한국주민등록번호 )/ 성명 / Full name Whether Date of birth (or Korean 주소 / Address disabled or Resident Registration No.) not 아니오 /No 가입자와의관계 / Relationship to contributor b) 위피부양자중에서한국국민연금급여를받고있는사람이있습니까? /Are any of the dependents listed above receiving any benefit under the Korean National Pension Act? 예 라면그의성명, 한국국민연금번호및급여유형은? / If Yes, what is his/her name, Korean National Pension Number and the type of benefit? 성명 / Full name 한국국민연금번호 / Korean National Pension Number 급여유형 / Type of benefit 5. 급여의선택 / Choice of Benefit 이름 / First Middle 성 /Last 노령연금 / Old Age Pension 장애연금 / Disability Pension 유족연금 / Survivor Pension 반환일시금 / Lump Sum Refund 분할연금 / Divided Pension *2 이상의급여수급자격이있는경우에만표시하십시오. / Please mark benefits with an (x) only if you are eligible for two or more. a) 발생급여 / Eligible benefits 노령연금 / Old Age Pension 장애연금 / Disability Pension 유족연금 / Survivor Pension 반환일시금 / Lump Sum Refund 분할연금 / Divided Pension b) 선택급여 / Benefit chosen 노령연금 / Old Age Pension 장애연금 / Disability Pension 유족연금 / Survivor Pension 반환일시금 / Lump Sum Refund 분할연금 / Divided Pension 6. 대리청구 ( 대리인에의한청구의경우에만기재하십시오 ) / Application by an agent/representative (Please fill in only if it is an application by an agent/representative.) * 대리인의자격에관한증빙자료를첨부하십시오. / Please attach supporting documentation concerning the agent's qualifications.

a) 대리청구사유 / Reason for application by agent/representative 미성년자 / Minor 한정치산자또는금치산자 / Incompetent 해외체류 / Stay abroad 군복무 / Military service 수감 / Imprisonment 기타 / Other b) 대리인성명 / Name of agent/representative 이름 / First Middle 성 / Last d) 주소 / Address ( 우편번호 / Postal code) c) 전화번호 / Telephone number e) 전자우편주소 / E-mail address f) 수급권자와의관계 / Relationship to beneficiary g) 수급권자의서명 / Signature of beneficiary B. 노령연금청구 / APPLICATION FOR AN OLD AGE PENSION 1. 귀하가 65 세미만인경우소득활동에종사하고있습니까? / If you are less than age 65, are you still working? 예 라면, 소득액 / If Yes, amount of earnings per 일 /day, 주 /week, 월 /month, 년 /year 1-1. 귀하의소득유형을기재하여주십시오. / Mark your income type with an (x). 자영업 / Self-employed 근로 / Employed * 귀하는 65 세이전에소득활동을중단하시거나다시시작하시다면한국국민연금관리공단에즉시신고하셔야합니다. / If you stop or resume working prior to age 65, you must notify without delay the Korean National Pension Service of that fact. 2. 귀하가 55 세이상 65 세미만인때에한국의고용보험법에의한구직급여를받았습니까? / Have you received a job seeker s benefit under the Korean Employment Insurance Act between age 55 and age 65? C. 분할연금청구 / APPLICATION FOR A DIVIDED PENSION 노령연금수급권자에관한정보 / Information on beneficiary of Old Age Pension 성명 / Full name 한국국민연금번호 / Korean National Pension Number 노령연금수급권발생일 / Beginning date of eligibility for Old Age Pension 혼인유지기간 / Period of marriage or cohabitation ( 월 /M 일 /D 연 /Y ~ 월 /M 일 /D 연 /Y) ~ ~ ~

D. 장애연금청구 / APPLICATION FOR A DISABILITY PENSION 1. 장애에관한정보 / Information concerning disability a) 장애발생일 / Date of onset of disability 월 /M 일 / D 연 / Y c) 장애발생경위 / History of disability b) 장애의원인 / Cause of disability 질병 / Disease 부상 / Injury 초진 / First medical examination 최종진단 / Final medical examination 진료기관 / Institution 소재지 / Location 기간 / Period 진단명 / Diagnosis 2. 귀하의장애로한국의산업재해보상보험법, 근로기준법또는선원법에의한급여를받았습니까? / Have you received a disability benefit under the Korean Industrial Accident Compensation Insurance Act, the Korean Labor Standards Act or the Korean Seamen s Act due to your disability? 3. 귀하가제 3 자의가해로장애를입은경우그가해자로부터손해배상금을받았습니까? / In the case of a disability caused by a third person, have you received an indemnity from him/her? 예 라면, 받은배상금액 / If Yes, indicate the amount of indemnity received. 4. 제 3 자에관한정보 / Information about the third person(s) * 제 3 자가 2 인이상일경우에는별지에아래사항을기재하십시오. / If the third persons are two or more, please fill in the information for the items below using a separate sheet. a) 개인일경우 / In the case of an individual 생년월일 ( 한국주민등록번호 ) / 성명 / Full name Date of birth 이름 / First Middle 성 /Last (or Korean Resident Registration No.) 주소 / ( 우편번호 / Postal code) Address 전화번호 / Telephone number b) 법인일경우 / In the case of a corporation 법인명 / Name of corporation 법인주소 /Address of corporation 전화번호 / Telephone number 전자우편주소 / E-mail address 사업자등록번호 / Business registration number 대표자성명및생년월일 / Name and birth date of representative of corporation 5. 본인은장애호전사항이있는경우즉시그사실을한국국민연금관리공단에통보할것에동의합니다. / If there is any improvement in my medical condition, I agree to notify without delay the Korean National Pension Service of that fact. 가입자또는청구인서명 / Signature of contributor/applicant

E. 유족연금청구 / APPLICATION FOR A SURVIVOR PENSION 1. 사망에관한정보 / Information concerning death a) 사망일 / Date of death 사망추정일 / Presumed date of death 월 /M 일 /D 년 / Y b) 사망장소 / Place of death 사망추정장소 / Presumed place of death c) 사망의원인 / Cause of death 질병 / Disease 사고 / Accident 기타 / Other ( ) d) 사망경위 ( 질병의경우병력을포함하십시오 ) / Relevant information concerning cause of death (Please include time line if by disease) 2. 동순위수급권자에관한정보 / Information on beneficiaries of equal standing * 귀하를포함하여동순위수급권자가 2 인이상인경우에만기재하십시오./ Please fill in only if there are two or more beneficiaries of equal standing, including yourself. a) 동순위수급권자수 / Number of beneficiaries of equal standing: 명 /Persons * 동순위수급권자 : 18 세미만유족자녀, 60 세이상유족부모등 / Beneficiaries of equal standing: surviving children less than age 18, surviving parents over age 60, etc. b) 귀하가동순위수급권자의대표자로선정되었을경우아래사항을기재하시고, 다른동순위수급권자의인감증명서나서명인증서를첨부하십시오. / If you have been designated as the representative of the beneficiaries of equal standing, please fill in the items below and attach a certificate of registered seal or certificate of signature for each of the other beneficiaries of equal standing. 성명 / Full name 생년월일 ( 한국주민등록번호 ) / Date of birth (or Korean Resident Registration No.) 주소 / Address 가입자와의관계 / Relationship to contributor 서명 ( 날인 ) / Signature (Registered seal) 이름 /First Middle 성 /Last 이름 /First Middle 성 /Last 이름 /First Middle 성 /Last 3. 귀하는가입자사망에대해한국의산업재해보상보험법, 근로기준법또는선원법에의한급여를받았습니까? / Have you received a Survivor Benefit due to the death of the contributor under the Korean Industrial Accident Compensation Insurance Act, the Korean Labor Standards Act or the Korean Seamen s Act?

4. 가입자가제 3 자의가해로사망한경우, 귀하는제 3 자로부터손해배상금을받았습니까? / In the case where the death of the contributor was caused by a third person, have you received an indemnity from him/her? 예 라면, 받은배상금액 / If Yes, indicate the amount of indemnity received. 5. 제 3 자에관한정보 / Information about the third person(s) * 제 3 자가 2 인이상일경우에는별지에아래사항을기재하십시오. / If there are two or more third persons, please fill in the information for the items below using a separate sheet. a) 개인일경우 / In the case of an individual 성명 / Full name 이름 /First Middle 성 /Last 생년월일 ( 한국주민등록번호 ) /Date of birth (or Korean Resident Registration No.) 주소 / Address 전화번호 / Telephone number 전자우편주소 / E-mail address b) 법인일경우 / In the case of a corporation 법인명 / Name of corporation 사업자등록번호 / Business registration number 법인주소 / Address of corporation 전화번호 / Telephone number 전자우편주소 / E-mail address

F. 일시금지급청구 / APPLICATION FOR A LUMP SUM BENEFIT 1. 일시금지급청구사유는무엇입니까? / What is the reason for applying for a lump sum benefit? 가입자사망 / Death of the contributor 60 세도달 / Reaching age 60 국적상실 ( 국외이주 ) / Loss of Korean nationality (Emigration from Korea) 한국의타공적연금가입 / Being insured under any other public pension scheme in Korea 2. 가입자가사망한경우에만기재하십시오. / Please fill in only if the contributor is deceased. a) 사망일 / Date of death 사망추정일 / Presumed date of death 월 /M 일 /D 년 / Y c) 사망원인 / Cause of death d) 사망경위 ( 질병의경우병력을포함하십시오 ) / Relevant information concerning cause of death (Please include time line if by disease) b) 사망장소 / Place of death 사망추정장소 / Presumed place of death 질병 / Disease 사고 / Accident 기타 / Other ( ) 3. 동순위수급권자에관한정보 / Information on beneficiaries of equal standing * 귀하를포함하여동순위수급권자가 2 인이상인경우에만기재하십시오./ Please fill in only if there are two or more beneficiaries of equal standing, including yourself. a) 동순위수급권자수 / Number of beneficiaries of equal standing: 명 /Persons * 가입자사망에의한반환일시금의동순위수급권자 : 18 세미만유족자녀, 60 세이상유족부모등 Beneficiaries of equal standing for the Lump Sum Refund due to the death of the contributor: surviving children less than age 18, surviving parents over age 60, etc. * 가입자사망에의한사망일시금의동순위수급권자 : 18 세이상유족자녀, 60 세미만유족부모, 형제자매등 Beneficiaries of equal standing for the Lump Sum Death Benefit due to the death of the contributor: surviving children over age 18, surviving parents less than age 60, siblings, etc. b) 귀하가동순위수급권자의대표자로선정되었을경우아래사항을기재하시고, 다른동순위수급권자의인감증명서나서명인증서를첨부하십시오./ If you have been designated as the representative of the beneficiaries of equal standing, please fill in the items below and attach a certificate of registered seal or certificate of signature for each of the other beneficiaries of equal standing. 성명 / Full name 생년월일 ( 한국주민등록번호 ) / Date of birth (or Korean Resident Registration No.) 주소 / Address 서명 ( 날인 ) / Signature (Registered seal) 이름 /First Middle 성 /Last 이름 /First Middle 성 /Last 이름 /First Middle 성 /Last

4. 확인사항 / Confirmation * 반환일시금을지급받으면노령연금, 장애연금또는유족연금을지급받을수없게된다는사실을알고있음에도불구하고반환일시금을청구하고자합니다. / By agreeing to accept a Lump Sum Refund, I understand that I cannot receive the Old Age Pension, Disability Pension or Survivor Pension. 수급권자성명 / Name of beneficiary: 서명 / Signature G. 급여수급방법 / METHOD OF PAYMENT OF BENEFIT * 계좌이체의경우청구인의성명및계좌번호를포함한계좌증빙서류를제출하십시오. / Please submit a bank statement that includes the applicant s name and account number in case of a direct deposit. * 계좌명의는청구인의이름과동일해야합니다. / The account must be opened in the applicant s name. 한국내통장계좌이체 / Direct deposit (to Korean bank only) 은행명 / Bank name 계좌번호 / Account number 예금주 / Account holder 송금희망화폐 / Preferred currency for remittance 수표 ( 한국외주소 ) / Cheque (to non- Korean Address) 수표수취희망주소 / Preferred address to which cheque is sent 해외송금 /Overseas Remittance 한국외통장계좌이체 / Direct deposit (to non-korean bank) * 금융기관명및계좌번호를아래에기재하십시오./ Please provide your financial institution and account number below. 지급상대국 / Country 은행 & 지점명 / Bank & branch name 은행 & 지점번호 / Bank & branch number 은행주소 / Bank address * 사서함은기재하지마십시오. / P.O. Box numbers are not accepted. 예금주 / 계좌번호 / Account number Account holder * 송금희망화폐는아래의통화중에서선택하셔야합니다. / Your preferred currency for remittance should be chosen from among the following. 국가통화국가통화국가통화 미국 USD 캐나다 CAD 호주 AUD 일본 JPY 스위스 CHF 홍콩 HKD 영국 GBP 스웨덴 SEK 유로 EUR * 다만, 부득이한경우선택한통화대신 USD 로송금될수있습니다. / In certain unavoidable circumstances, payment may be made in USD instead of the currency chosen.

해외송금규정요약 / Summary of the General Terms and Conditions of Overseas Remittance 1. 수급권자본인이청구하는경우는해외송금방법에의하여수급권자본인에게지급하고국내거주대리인이청구하는경우는대리인에게지급합니다./ A benefit for which a beneficiary applies abroad shall be directly paid to the beneficiary. And if, on behalf of a beneficiary abroad, his/her agent in Korea applies for a benefit, the benefit will be paid to the agent in Korea. 2. 급여를해외송금할경우전신송금환을원칙으로하고수급권자가원할경우송금수표도인정하되, 송금수수료및국제전신료, 국외은행수수료등해외송금비중전신송금환에따르는송금수수료및국제전신료 ( 또는송금수표송부에따르는송금수수료및우편요금 ) 는한국국민연금관리공단이부담하고그이외의송금비용은수급권자본인이부담하게됩니다. 다만, 수급권자의계좌불명등본인의과실에의한송금수수료및국제전신료 ( 또는송금수표송부에따르는송금수수료및우편요금 ) 는수급권자본인이부담하게됩니다. / In the case of overseas remittance, the payment will be made primarily by direct deposit. If the beneficiary wishes, the payment may also be made by cheque. Of the overseas remittance expenses such as remittance fees, international cable charges and fees charged by foreign banks, the Korean National Pension Service will cover the remittance fees and international cable charges related to direct deposits (or the remittance fees and postal charges related to the sending of cheques), and the beneficiary himself or herself will cover the remittance expenses other than these. Furthermore, the beneficiary himself or herself will cover the remittance fees and international cable charges (or the remittance fees and postal charges related to the sending of cheques) that are due to the beneficiary's fault such as failure to identify his or her account. 3. 급여를해외송금할경우급여액은고시통화중에서수급권자가지정한화폐또는 US 달러로지급하되그당시환율 ( 전신환매도율 ) 에의하여지급합니다. / The benefit will be paid in a currency chosen by the beneficiary from among the currencies listed or in USD. The conversion rate will be the direct deposit selling rate for the day on which the payment is made. H. 급여유형별첨부서류 / DOCUMENTS TO BE SUBMITTED BY TYPE OF BENEFIT 청구인은서류원본또는확인된사본을제출해야합니다. / An applicant must submit the original documents or certified true copies of the original documents. 공통서류 / Documents for all benefits 연금공통 ( 일시금제외 ) / Documents for all benefits except lump sum - 청구인의신분증명 : 한국주민등록증 / 외국인등록증및여권 / Proof of the applicant's identity: the Korean resident registration card / alien registration card and the passport - 수급권자의은행계좌증빙서류 : 수급권자본인의은행통장사본등 Proof of the beneficiary s bank account: a copy of the beneficiary's own bank book, etc. - 대리청구의경우대리권한에관한증빙서류 : 인감증명서등 / Proof of authority to act as an agent in the case of an application by an agent: a certificate of registered seal, etc. - 청구인의거주지를증명할수있는서류 : 대한민국내거주시에는주민등록등본또는외국인등록사실증명원등, 국외거주시에는해당국의거주사실증명 / A document proving the residence of the applicant(s): In the case of residence in Korea, a certificate of resident registration or a certificate of alien registration. In the case of residence in another country, proof of residence in that country. - 가입자의배우자에관한생계유지입증서류 : 결혼증명서또는한국주민등록등본및호적등본또는사실혼증명 / Evidence of the fact that the contributor s spouse has been supported by him/her: a marriage certificate, a Korean certificate of resident registration and a copy of the family census register or proof of a common-law relationship - 배우자를제외한가입자의피부양자에관한생계유지입증서류 : 피부양자의출생증명서, 세례증명서, 또는한국주민등록등본, 그리고 18 세이상피부양장애자녀와 60 세미만피부양장애부모의경우장애증명 / Evidence of the fact that the contributor s dependents other than his/her spouse have been supported by the contributor: a birth or baptismal certificate or a Korean certificate of resident registration for each dependent supported by the contributor, and proof of disability for disabled children over age 18 or disabled parents less than age 60 supported by the contributor.

분할연금인경우 / Divided Pension only 장애연금인경우 / Disability Pension only 유족연금인경우 / Survivor Pension only 일시금인경우 / Lump sum only - 청구인이노령연금수급권자의배우자이었음을증명할수있는서류 : 결혼증명서등 / Proof that the applicant had been the spouse of the Old Age Pension beneficiary: a marriage certificate, etc. - 청구인이노령연금수급권자와이혼하였음을증명할수있는서류 : 이혼증명서등 / Proof that the applicant has divorced the Old Age Pension beneficiary: a divorce certificate, etc. - 가입자의장애진단서 / Medical report concerning contributor's disability - ( 사망한 ) 가입자의신분증명 : 한국주민등록증, 외국인등록증또는여권등 / Proof of the (deceased) contributor's identity: the Korean resident registration card, the alien registration card or the passport, etc. - 사망증명서 / A death certificate - 귀하가동순위수급권자의대표자로선정된경우다른동순위수급권자의인감증명서나서명인증서 / If you have been designated as the representative of the other beneficiaries of equal standing, a certificate of registered seal or certificate of signature for each beneficiary - 가입자사망의경우 : 유족연금제출서류와동일 / In the case of the death of the contributor: the same documents as for the Survivor Pension - 국외이주의경우 : 영구출국사실을증명할수있는서류 ( 예, 비행기티켓또는출입국사실증명 ) / In the case of emigration from Korea: a document showing proof of permanent departure from Korea (examples: airline ticket, proof of entering and leaving Korea, etc.) - 한국의타공적연금에가입중인경우 : 해당공적연금가입증명및재직증명원 / In the case of coverage under any other public pension scheme in Korea: a certificate of coverage under the relevant scheme and a certificate of employment

I. 청구인의서명란 / TO BE SIGNED BY THE APPLICANT 본인은한국국민연금법의규정에따라위와같이급여를청구하며본청구서에기재된정보가사실임을확인합니다. 본인은허위또는불법적인방법으로한국급여를지급받은자는그수급권이없는지급금액을반환하여야할뿐만아니라한국국민연금법에따라처벌받을수있다는것을알고있습니다. 또한본인은해외송금을신청함에있어한국국민연금관리공단에서정한해외송금규정을숙 지하고그내용에따를것을확인합니다. 본인은본급여청구서와관련되거나관련될수있는모든정보와증거를서비스캐나다에 제공하도록한국국민연금관리공단에위임하며, 또한본급여청구서와관련되거나관련될수 있는모든정보와증거를한국국민연금관리공단에제공하도록서비스캐나다에위임합니다. I hereby apply for the benefits indicated above under the provisions of the Korean National Pension Act. I declare that the information given in this application is true. I know that anyone who receives Korean benefits in a false or illegal way may be punished under the Korean National Pension Act, in addition to having to repay the Korean benefits for which there is no entitlement. I hereby declare, in applying for an overseas remittance, that I understand the General Terms and Conditions of Overseas Remittance established by the Korean National Pension Service and promise to abide by them. I authorize the Korean National Pension Service to furnish to Service Canada all of the information and evidence in its possession that relates or could relate to this application for benefits. I also authorize Service Canada to furnish to the Korean National Pension Service all of the information and evidence in its possession that relates or could relate to this application for benefits. 청구일 / 청구인서명 / Date of application Signature of applicant 월 /M 일 /D 년 /Y J. 캐나다실무기관의확인 / CONFIRMATION BY THE AGENCY IN CANADA 급여청구서접수일 / Date of receipt 월 /M 일 /D 년 /Y 서명 / Verified by 직인 / Official Seal

Canada / Korea Agreement Documents and/or information required to support your application [CAN-KOR 1] for a Korean Old Age Pension The applicant must submit originals or certified copies of the following: Birth certificate of Korean resident registration card (applicant, dependents claimed in question 3A) of Part A) Marriage certificate, Korean resident registration card or proof of common-law relationship( if married/common law and claiming dependents) The following original documents (if applicable) must accompany the application to Korea: Proof of disability for disabled children over age 18 and or disabled parents under age 60 (if claiming dependents in question 3a)of part A) IMPORTANT: If you have already submitted any of the documents required when you applied for a Canada Pension Plan or Old Age Security benefit, you do not need to resubmit them.