Sick and Disability Benefits Overview Long-term income protection (LTIP) You continue to accumulate credit in the Ontario Teachers’ Pension Plan while you receive: • sick pay or long-term income protection (LTIP) through your employer; or • payments for loss of earnings from the Workplace Safety & Insurance Board (WSIB). In most cases, this applies even if you’re on integrated sick leave or rehabilitative employment. As long as you’re receiving WSIB loss of earnings benefits or benefits under a valid LTIP agreement with your employer, your credit can grow seamlessly until you start your pension. If you began collecting LTIP through your employer as a result of a disability that occurred after Aug. 31, 2001, your pension contributions are waived and your pensionable salary is adjusted automatically for inflation each subsequent school year at no cost to you. This helps you build the biggest pension possible during your absence from work. If you’re like most disabled members, you may find it is best to stay on WSIB or LTIP benefits for as long as you can, especially if your employer continues to provide benefits such as health and life insurance. Carefully weigh your options before making any decisions. Purchasing credit You don’t accumulate credit during a break in employment for health reasons unless you receive WSIB benefits, sick pay or LTIP benefits through an employer-sponsored program. You can apply, however, to buy back such absences due to ill health. For more information on buying back credit, visit our website or contact us. Who qualifies? If you become disabled while employed in education, you may be eligible for a disability pension. To qualify, you must: • have at least 10 qualifying years of service in the Ontario Teachers’ Pension Plan; • terminate employment in education and stop receiving any LTIP or WSIB loss of earnings benefits; • provide full and complete documentation of medical evidence that meets the requirements of the plan for a full or partial disability pension, as of the date you terminated employment; and • be under age 65. You must submit a pension application within two years of your termination of employment in education. An application will be accepted after the two-year deadline only if a late diagnosis or your disability prohibited you from applying on time. 0487 (01/18) 5650 Yonge Street, Toronto, Ontario M2M 4H5 Website: www.otpp.com 416 226-2700 or 1 800 668-0105 Fax 416 730-7807 or 1 800 949-8208 Disability pensions
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Transcript
Sick and Disability Benefits Overview
Long-term income
protection (LTIP)You continue to accumulate credit in the Ontario Teachers’ Pension Plan while you
receive:
• sick pay or long-term income protection (LTIP) through your employer; or
• payments for loss of earnings from the Workplace Safety & Insurance Board (WSIB).
In most cases, this applies even if you’re on integrated sick leave or rehabilitative
employment. As long as you’re receiving WSIB loss of earnings benefits or benefits under
a valid LTIP agreement with your employer, your credit can grow seamlessly until you
start your pension.
If you began collecting LTIP through your employer as a result of a disability that
occurred after Aug. 31, 2001, your pension contributions are waived and your
pensionable salary is adjusted automatically for inflation each subsequent school year at
no cost to you. This helps you build the biggest pension possible during your absence
from work.
If you’re like most disabled members, you may find it is best to stay on WSIB or LTIP
benefits for as long as you can, especially if your employer continues to provide
benefits such as health and life insurance. Carefully weigh your options before making
any decisions.
Purchasing credit
You don’t accumulate credit during a break in employment for health reasons unless you
receive WSIB benefits, sick pay or LTIP benefits through an employer-sponsored program.
You can apply, however, to buy back such absences due to ill health. For more
information on buying back credit, visit our website or contact us.
Who qualifies?
If you become disabled while employed in education, you may be eligible for a disability
pension. To qualify, you must:
• have at least 10 qualifying years of service in the Ontario Teachers’ Pension Plan;
• terminate employment in education and stop receiving any LTIP or WSIB loss of
earnings benefits;
• provide full and complete documentation of medical evidence that meets the
requirements of the plan for a full or partial disability pension, as of the date you
terminated employment; and
• be under age 65.
You must submit a pension application within two years of your termination of
employment in education. An application will be accepted after the two-year deadline
only if a late diagnosis or your disability prohibited you from applying on time.
416 226.2700 or 1 800 668.0105 Fax 416 730.7807 or 1 800 949.8208
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1
Describe the symptoms of your medical condition and how it affects your ability to work
Describe your daily routine
When did your disability begin?
Do you expect your medical condition to improve with appropriate medical care? � Yes � No
To what extent are you disabled now?
� Partially (unable to work in education but other employment is possible, or there is a possibility your health
will improve)
� Fully (unable to work at any job at this time)
Are you confined? � No � Yes � If yes, confined to: � Bed � Hospital or institution
� House � Other
Date confinement began
Have you done any type of work since your last day of employment in education? � Yes � No
If yes, please specify the following:
Dates of employment Type of work Income earned?
� Yes � No
� Yes � No
� Yes � No
Are you able to do any type of work now? � Yes � No
If no, do you expect you will ever recover sufficiently to work again? � Yes � No
If yes, please specify the following:
Date able to start Type of work
Description of
disability
Depending on the extent
of your disability, you
may be entitled to a partial
or full disability pension.
2
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Examination
Onset of illness Onset of disability
Height Weight Blood pressure
Relevant previous medical history (especially at resignation from employment)
Significant abnormalities
Diagnosis (If more than one, list in order of significance regarding current disability)
Has the patient made reasonable efforts towards recovery or rehabilitation? � Yes� No
Please explain.
Examination
PART 2 To be completed by the Medical Examiner
Your patient is applying for an Ontario Teachers’ Pension Plan benefit. Eligibility for disability
pensions is based on the patient’s condition when he or she resigns from employment.
Please include as much detail as possible about the patient’s condition at resignation. If
unable to do so, please indicate why.
Conclusion and
recommendation
Any fees associated with
the examination and the
completion of this report
are the responsibility of
the patient.
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3
Conclusion and
recommendation
(cont’d)
Is the patient able to teach or perform duties of the employment in which
he or she was engaged immediately prior to the period of disability? � Yes � No
If no, do you have any suggestions for rehabilitation? � Yes � No
If yes, please explain.
Will the patient ever recover sufficiently to resume part-time
or full-time employment in education? � Yes � No
If yes, please indicate approximately when.
Is the patient able to work in some other capacity? � Yes � No
If yes, please explain.
If no, will the patient ever recover sufficiently to work at all? � Yes � No
If yes, approximately when?
Is further investigation needed before a pension is awarded? � Yes � No
If yes, please explain.
Summary, recommendation and any additional information
Would access to this information prejudice the patient’s health? � Yes � No
Name Professional qualification
Address street city
province postal code
Signature Date
Signature of
medical examiner
Please include copies
of any documents and
reports from other
doctors or specialists.
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4
I, ___________________________ , certify that the information I have provided on this form
is true and complete.
I authorize the Ontario Teachers’ Pension Plan (Ontario Teachers’) to collect, use, maintain,
transfer and disclose my personal information to the extent reasonably necessary for the
purposes of the assessment, investigation, administration and adjudication of my claim for
Ontario Teachers’ Disability Pension (the “Benefit Purposes”). I authorize any physician or
other health care professional or provider, health care facility, or any other person with
information relevant to the Benefit Purposes to disclose such information to Ontario
Teachers’, its medical referee(s) or authorized contractors for the Benefit Purposes.
Signature Date
Applicant’s
authorization
and signature
PART 3 To be completed by the Applicant
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5
Protected B when completed
TD12020 Personal Tax Credits Return
Read page 2 before filling out this form. Your employer or payer will use this form to determine the amount of your tax deductions.
Fill out this form based on the best estimate of your circumstances.
Last name First name and initial(s) Date of birth (YYYY/MM/DD) Employee number
Address Postal code For non-residents only – Country of permanent residence
Social insurance number
1. Basic personal amount – Every resident of Canada can claim this amount. If your net income from all sources for the year will be $150,473 or less, enter $13,229.If your net income will be between $150,473 and $214,368 and you want to calculate a partial claim, get Form TD1-WS, Worksheet for the 2020 Personal Tax Credits Return, and fill in the appropriate section. If your net income will be between $150,473 and $214,368 and you do not want to calculate a partial claim, or if it will be more than $214,368, enter $12,298. If you will have more than one employer or payer at the same time in 2020, see "More than one employer or payer at the same time" on page 2. If you are a non-resident, see "Non-residents" on page 2.
2. Canada caregiver amount for infirm children under age 18 – Either parent (but not both), may claim $2,273 for each infirm child born in 2003 or later, that resides with both parents throughout the year. If the child does not reside with both parents throughout the year, the parent who is entitled to claim the “Amount for an eligible dependant” on line 8 may also claim the Canada caregiver amount for that same child who is under age 18.
3. Age amount – If you will be 65 or older on December 31, 2020, and your net income for the year from all sources will be $38,508 or less, enter $7,637. If your net income for the year will be between $38,508 and $89,422 and you want to calculate a partial claim, get Form TD1-WS, Worksheet for the 2020 Personal Tax Credits Return, and fill in the appropriate section.
4. Pension income amount – If you will receive regular pension payments from a pension plan or fund (excluding Canada Pension Plan, Quebec Pension Plan, Old Age Security, or Guaranteed Income Supplement payments), enter $2,000 or your estimated annual pension income, whichever is less.
5. Tuition (full time and part time) – If you are a student enrolled at a university or college, or an educational institution certified by Employment and Social Development Canada, and you will pay more than $100 per institution in tuition fees, fill in this section. If you are enrolled full time or part time, enter the total of the tuition fees you will pay.
6. Disability amount – If you will claim the disability amount on your income tax and benefit return by using Form T2201, Disability Tax Credit Certificate, enter $8,576.
7. Spouse or common-law partner amount – If you are supporting your spouse or common-law partner who lives with you and whose net income for the year will be less than Line 1 (Line 1 plus $2,273 if they are infirm), enter the difference between this amount and their estimated net income for the year. If their net income for the year will be Line 1 or more (Line 1 plus $2,273 if they are infirm), you cannot claim this amount. In all cases, if their net income for the year will be $24,361 or less and they are infirm,go to line 9.
8. Amount for an eligible dependant – If you do not have a spouse or common-law partner and you support a dependent relative who lives with you and whose net income for the year will be less than Line 1 (Line 1 plus $2,273 if they are infirm and you cannotclaim the Canada caregiver amount for children under age 18 for this dependant), enter the difference between this amount and their estimated net income. If their net income for the year will be Line 1 or more (Line 1 plus $2,273 or more if they are infirm), you cannot claim this amount. In all cases, if their net income for the year will be $24,361 or less and they are infirm and are age 18 or older, go to line 9.
9. Canada caregiver amount for eligible dependant or spouse or common-law partner – If, at any time in the year, you support an infirm eligible dependant (aged 18 or older) or an infirm spouse or common-law partner whose net income for the year will be $24,361 or less, get Form TD1-WS and fill in the appropriate section.
10. Canada caregiver amount for dependant(s) age 18 or older – If, at any time in the year, you support an infirm dependant age 18 or older (other than the spouse or common-law partner or eligible dependant you claimed an amount for on line 9, or could have claimed an amount for if their net income were under $15,502) whose net income for the year will be $17,085 or less, enter $7,276. If their net income for the year will be between $17,085 and $24,361 and you want to calculate a partial claim, get Form TD1-WS and fill in the appropriate section. You can claim this amount for more than one infirm dependant age 18 or older. If you are sharing this amount with another caregiver who supports the same dependant, get the Form TD1-WS and fill in the appropriate section.
11. Amounts transferred from your spouse or common-law partner – If your spouse or common-law partner will not use all of their age amount, pension income amount, tuition amount, or disability amount on their income tax and benefit return, enter the unused amount.
12. Amounts transferred from a dependant – If your dependant will not use all of their disability amount on their income tax and benefit return, enter the unused amount. If your or your spouse's or common-law partner's dependent child orgrandchild will not use all of their tuition amount on their income tax and benefit return, enter the unused amount.
13. TOTAL CLAIM AMOUNT – Add lines 1 to 12. Your employer or payer will use this amount to determine the amount of your tax deductions.
TD1 E (01/20) (Ce formulaire est disponible en français.) Page 1 of 2
Protected B when completed
Filling out Form TD1 Fill out this form only if any of the following apply:
• you have a new employer or payer and you will receive salary, wages, commissions, pensions, employment insurance benefits,or any other remuneration
• you want to change amounts you previously claimed (for example, the number of your eligible dependants has changed)
• you want to claim the deduction for living in a prescribed zone
• you want to increase the amount of tax deducted at source
Sign and date it, and give it to your employer or payer.
If you do not fill out Form TD1, your employer or payer will deduct taxes after allowing the basic personal amount only.
More than one employer or payer at the same time
If you have more than one employer or payer at the same time and you have already claimed personal tax credit amounts on another Form TD1 for 2020, you cannot claim them again. If your total income from all sources will be more than the personal tax credits you claimed on another Form TD1, check this box, enter "0" on line 13 and do not fill in lines 2 to 12.
Total income less than total claim amount
Check this box if your total income for the year from all employers and payers will be less than your total claim amount on line 13. Your employer or payer will not deduct tax from your earnings.
Non-residents (Only fill in if you are a non-resident of Canada.)As a non-resident of Canada, will 90% or more of your world income be included in determining your taxable income earned in Canada in 2020?
Yes (Fill out the previous page.)
No (Enter "0" on line 13, and do not fill in lines 2 to 12 as you are not entitled to the personal tax credits.)
If you are unsure of your residency status, call the international tax and non-resident enquiries line at 1-800-959-8281.
Provincial or territorial personal tax credits returnIf your claim amount on line 13 is more than $13,229, you also have to fill out a provincial or territorial TD1 form. If you are an employee, use the Form TD1 for your province or territory of employment. If you are a pensioner, use the Form TD1 for your province or territory of residence. Your employer or payer will use both this federal form and your most recent provincial or territorial Form TD1 to determine the amount of your tax deductions.
If you are claiming the basic personal amount only, your employer or payer will deduct provincial or territorial taxes after allowing the provincial or territorial basic personal amount.
Note: If you are a Saskatchewan resident supporting children under 18 at any time during 2020, you may be able to claim the child amount on Form TD1SK, 2020 Saskatchewan Personal Tax Credits Return. Therefore, you may want to fill out Form TD1SK even if you are only claiming the basic personal amount on this form.
Deduction for living in a prescribed zoneIf you live in the Northwest Territories, Nunavut, Yukon, or another prescribed northern zone for more than six months in a row beginning or ending in 2020, you can claim any of the following:
• $11.00 for each day that you live in the prescribed northern zone
• $22.00 for each day that you live in the prescribed northern zone if, during that time, you live in a dwelling that you maintain, and you are the only person living in that dwelling who is claiming this deduction
$Employees living in a prescribed intermediate zone can claim 50% of the total of the above amounts.For more information, go to canada.ca/taxes-northern-residents.
Additional tax to be deductedYou may want to have more tax deducted from each payment, especially if you receive other income, including non-employment income such as CPP or QPP benefits, or old age security pension. By doing this, you may not have to pay as much tax when you file your income tax and benefit return. To choose this option, state the amount of additional tax you want to have deducted from each payment. To change this deduction later, fill out a new Form TD1.
$
Reduction in tax deductionsYou can ask to have less tax deducted on your income tax and benefit return if you are eligible for deductions or non-refundable tax credits that are not listed on this form (for example, periodic contributions to a registered retirement savings plan (RRSP), child care or employment expenses, charitable donations, and tuition and education amounts carried forward from the previous year). To make this request, fill out Form T1213, Request to Reduce Tax Deductions at Source, to get a letter of authority from your tax services office. Give the letter of authority to your employer or payer. You do not need a letter of authority if your employer deducts RRSP contributions from your salary.
Forms and publicationsTo get our forms and publications, go to canada.ca/cra-forms-publications or call 1-800-959-5525.
Personal information (including the SIN) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and activities including administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other federal acts that provide for the imposition and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file a complaint to the Privacy Commissioner of Canada regarding the handling of the individual’s personal information. Refer to Personal Information Bank CRA PPU 120 on Info Source at canada.ca/cra-info-source.
Certification
I certify that the information given on this form is correct and complete.
SignatureIt is a serious offence to make a false return.
DateYYYY/MM/DD
Page 2 of 2
Protected B when completed
TD1-WSWorksheet for the 2020 Personal Tax Credits Return
Fill out this worksheet if you want to calculate partial claims for the following amounts on your Form TD1, 2020 Personal Tax Credits Return.Do not give your filled out worksheet to your employer or payer. Keep it for your records.
Line 1 of Form TD1 – Basic personal amountIf your estimated net income will be between $150,473 and $214,368, calculate your partial claim as follows:
1Base amount
2Your estimated net income for the year
3Income threshold –
4Line 2 minus line 3 (if negative, enter "0") =
5$63,895 minus line 4 =
6Divide line 5 by $63,895 =
7Applicable amount ×
8Multiply line 6 by line 7 = +
9Line 1 plus line 8Enter this amount on line 1 of Form TD1. =
Line 3 of Form TD1 – Age amountIf you will be 65 or older on December 31, 2020, and your estimated net income from all sources will be between $38,508 and $89,422, calculate your partial claim as follows:
1Maximum amount
2Your estimated net income for the year
3Base amount –4Line 2 minus line 3 (if negative, enter "0") =5Applicable rate ×
6Multiply line 4 by line 5 = –
7Line 1 minus line 6Enter this amount on line 3 of Form TD1. =
Line 9 of Form TD1 – Canada caregiver amount for eligible dependant or spouse or common-law partner
If the estimated net income of your infirm eligible dependant (aged 18 or older) or your infirm spouse or common-law partner, whichever applies, will be $24,361 or less for the year, calculate your claim as follows:
1Base amount
2Your infirm dependant's estimated net income for the year –
3Line 1 minus line 2 (maximum $7,276) =
4Enter the amount you claimed on line 7 or line 8, whichever applies, of Form TD1 for this dependant –
5Line 3 minus line 4 Enter this amount on line 9 of Form TD1 (if negative, enter "0"). =
Line 10 of Form TD1 – Canada caregiver amount for dependant(s) age 18 or older
If the estimated net income of your infirm dependant (see notes below) will be between $17,085 and $24,361 for the year, calculate your partial claim as follows:
1Base amount
2Your infirm dependant's estimated net income for the year –
3Line 1 minus line 2 (maximum $7,276) =
4Enter the amount, if any, that will be claimed by the dependant's other caregiver –
5Line 3 minus line 4 Enter this amount on line 10 of Form TD1 (if negative, enter "0"). =
Notes: If you would like to claim this amount for more than one dependant, fill out a separate worksheet for each one. Add all of the amounts from line 5 of each worksheet and enter the total amount on line 10 of Form TD1. If you are claiming the Canada caregiver amount for spouse or common-law partner or for an eligible dependant, see line 9 above.
TD1-WS E (01/20) (Ce formulaire est disponible en français.)
12,298.00
150,473.00
931.00
7,637.00
38,508.00
15%
24,361.00
24,361.00
Protected B when completed
TD1ON2020 Ontario Personal Tax Credits Return
Read page 2 before filling out this form. Your employer or payer will use this form to determine the amount of your provincial tax deductions.
Fill out this form based on the best estimate of your circumstances.
Last name First name and initial(s) Date of birth (YYYY/MM/DD) Employee number
Address Postal code For non-residents only – Country of permanent residence
Social insurance number
1. Basic personal amount – Every person employed in Ontario and every pensioner residing in Ontario can claim this amount. If you will have more than one employer or payer at the same time in 2020, see "More than one employer or payer at the same time" on page 2.
2. Age amount – If you will be 65 or older on December 31, 2020, and your net income from all sources will be $39,193 or less, enter $5,265. If your net income for the year will be between $39,193 and $74,293 and you want to calculate a partial claim, get Form TD1ON-WS, Worksheet for the 2020 Ontario Personal Tax Credits Return, and fill in the appropriate section.
3. Pension income amount – If you will receive regular pension payments from a pension plan or fund (excluding Canada Pension Plan, Quebec Pension Plan, Old Age Security, or Guaranteed Income Supplement payments), enter $1,491, or your estimated annual pension income, whichever is less.
4. Disability amount – If you will claim the disability amount on your income tax and benefit return by using Form T2201, Disability Tax Credit Certificate, enter $8,712.
5. Spouse or common-law partner amount – If you are supporting your spouse or common-law partner who lives with you and whose net income for the year will be $915 or less, enter $9,156. If their net income for the year will be between $915 and $10,071 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section.
6. Amount for an eligible dependant – If you do not have a spouse or common-law partner and you support a dependent relative who lives with you and whose net income for the year will be $915 or less, enter $9,156. If their net income for the year will be between $915 and $10,071 and you want to calculate a partial claim, get Form TD1ON-WS and fill in the appropriate section.
7. Ontario caregiver amount – You may be supporting an eligible infirm dependant aged 18 or older who is either your or your spouse's or common-law partner's:
• child or grandchild
• parent, grandparent, brother, sister, aunt, uncle, niece or nephew who is resident in Canada
If this is your situation, get Form TD1ON-WS and fill in the appropriate section.
8. Amounts transferred from your spouse or common-law partner – If your spouse or common-law partner will not use all of their age amount, pension income amount, or disability amount on their income tax and benefit return, enter the unused amount.
9. Amounts transferred from a dependant – If your dependant will not use all of their disability amount on their income tax and benefit return, enter the unused amount.
10. TOTAL CLAIM AMOUNT – Add lines 1 to 9.Your employer or payer will use this amount to determine the amount of your provincial tax deductions.
TD1ON E (20) (Ce formulaire est disponible en français.) Page 1 of 2
10,783
Protected B when completed
Filling out Form TD1ONFill out this form only if you are an employee working in Ontario or a pensioner residing in Ontario and any of the following apply:
• you have a new employer or payer and you will receive salary, wages, commissions, pensions, employment insurance benefits, or any other remuneration
• you want to change amounts you previously claimed (for example, the number of your eligible dependants has changed)
• you want to increase the amount of tax deducted at source
Sign and date it, and give it to your employer or payer.
If you do not fill out Form TD1ON, your employer or payer will deduct taxes after allowing the basic personal amount only.
More than one employer or payer at the same timeIf you have more than one employer or payer at the same time and you have already claimed personal tax credit amounts on another Form TD1ON for 2020, you cannot claim them again. If your total income from all sources will be more than the personal tax credits you claimed on another Form TD1ON, check this box, enter "0" on line 10 and do not fill in lines 2 to 9.
Total income less than total claim amountCheck this box if your total income for the year from all employers and payers will be less than your total claim amount on line 10.Your employer or payer will not deduct tax from your earnings.
Additional tax to be deductedIf you wish to have more tax deducted, fill in "Additional tax to be deducted" on the federal Form TD1.
Reduction in tax deductionsYou can ask to have less tax deducted on your income tax and benefit return if you are eligible for deductions or non-refundable tax credits that are not listed on this form (for example, periodic contributions to a registered retirement savings plan (RRSP), child care or employment expenses, charitable donations, and tuition and education amounts carried forward from the previous year). To make this request, fill out Form T1213, Request to Reduce Tax Deductions at Source, to get a letter of authority from your tax services office. Give the letter of authority to your employer or payer. You do not need a letter of authority if your employer deducts RRSP contributions from your salary.
Forms and publicationsTo get our forms and publications, go to canada.ca/cra-forms-publications or call 1-800-959-5525.
Personal information (including the SIN) is collected for the purposes of the administration or enforcement of the Income Tax Act and related programs and activities including administering tax, benefits, audit, compliance, and collection. The information collected may be used or disclosed for purposes of other federal acts that provide for the imposition and collection of a tax or duty. It may also be disclosed to other federal, provincial, territorial or foreign government institutions to the extent authorized by law. Failure to provide this information may result in interest payable, penalties or other actions. Under the Privacy Act, individuals have the right to access their personal information, request correction, or file a complaint to the Privacy Commissioner of Canada regarding the handling of the individual’s personal information. Refer to Personal Information Bank CRA PPU 120 on Info Source at canada.ca/cra-info-source.
Certification
I certify that the information given on this form is correct and complete.
SignatureIt is a serious offence to make a false return.
Date
Page 2 of 2
Protected B when completed
TD1ON-WSWorksheet for the 2020 OntarioPersonal Tax Credits Return
Fill out this worksheet if you want to calculate partial claims for the following amounts on Form TD1ON, 2020 Ontario Personal Tax Credits Return.
Do not give your filled out worksheet to your employer or payer. Keep it for your records.
Line 2 of Form TD1ON – Age amountIf you will be 65 or older on December 31, 2020, and your estimated net income from all sources will be between $39,193 and $74,293, calculate your partial claim as follows:
1Maximum amount
2Your estimated net income for the year
3Base amount –4Line 2 minus line 3 (if negative, enter "0") =5Applicable rate ×
6Multiply line 4 by line 5. = –
7Line 1 minus line 6Enter this amount on line 2 of Form TD1ON. =
Line 5 of Form TD1ON – Spouse or common-law partner amount
If your spouse or common-law partner's estimated net income for the year (including the income earned before and during the marriage or common-law relationship) will be between $915 and $10,071, calculate your partial claim as follows:
1Base amount
2Your spouse or common-law partner's estimated net income for the year –
3Line 1 minus line 2 (maximum $9,156, if negative, enter "0") Enter this amount on line 5 of Form TD1ON. =
Line 6 of Form TD1ON – Amount for an eligible dependantIf your dependant's estimated net income for the year will be between $915 and $10,071, calculate your partial claim as follows:
1Base amount
2Your eligible dependant's estimated net income for the year –
3Line 1 minus line 2 (maximum $9,156, if negative, enter "0") Enter this amount on line 6 of Form TD1ON. =
Line 7 of Form TD1ON – Ontario caregiver amountIf your dependant's estimated net income for the year will be between $17,388 and $22,470, calculate your claim as follows:
1Base amount
2Your dependant's estimated net income for the year –
3Line 1 minus line 2 (maximum $5,082, if negative, enter "0") =
4Enter the amount claimed for this dependant at line 6 of Form TD1ON. –
5Line 3 minus line 4 (if negative, enter "0") Enter this amount on line 7 of Form TD1ON. =
TD1ON-WS E (20) (Ce formulaire est disponible en français.)
5,265.00
39,193.00
15%
10,071.00
10,071.00
22,470.00
ddmmyyyy
Ontario Teachers’ Account Number Date of birth
Name last first
Address street city
province postal code
Telephone home work
I, , solemnly declare that I lived together with
in a continuous conjugal relationship from
to the present time.
1. Both my common-law spouse and I are the parents of a child: � Yes � No
� If yes, provide the following information for a child:
First name Last name Date of birth
� If child was adopted, also provide the date of adoption
2. My common-law spouse and I:
a) have jointly signed a residential lease, mortgage or purchase agreement relating to a
residence in which we both live(d) � Yes � No
b) jointly own(ed) property other than our residence � Yes � No
c) have joint bank, trust, credit union or charge card accounts � Yes � No
d) have declared each other as spouses on federal income tax returns � Yes � No
Statutory Declaration ofCommon-law Relationship
Part A –
to be completed
by member
1. The member completes Part A of this form then signs it before a Commissioner of Oaths.
2. A Commissioner of Oaths witnesses the member’s signing of the declaration then
completes Part B.
3. The member’s common-law spouse completes Part C.
416 226-2700 or 1 800 668-0105 Fax 416 730-7807 or 1 800 949-8208
How to waive
Please read this fact sheet before signing the Waiver of Joint and Survivor Pension.
“Living separate and
apart” means you are
no longer sharing a
spousal relationship
(i.e., having joint
finances, sharing a
conjugal relationship)
and intend to termi-
nate your relationship.
You can be living sepa-
rate and apart without
a formal separation
agreement and/or in
the same residence.
Member’s name
Member’s address
Date of birth
Prior to completing this form, each party should consider obtaining independent legal advice concerning their individual rights and the effect of this waiver.
NOTE: This waiver is not effective unless it is dated, signed and delivered to the Ontario Teachers’ Pension Plan within the 12-month period preceding the
commencement of payment of the pension benefit as required by subsection 46(2) of the Pension Benefits Act.
Refer to the Ontario Pension Benefits Act–R.S.O 1990, c.P.8, as amended, Form 3
Waiver
day month year
We, (referred to below as the “member”)
and ,(referred to below as the “spouse”)
certify that we are spouses within the meaning of the Ontario Pension Benefits Act.
We understand that section 44 of the Ontario Pension Benefits Act provides that the pension
paid to the member from the Ontario Teachers’ Pension Plan must be paid as a joint and
survivor pension if we are spouses on the date that the payment of the first installment of the
pension is due and if we are not living separate and apart at that time. We also understand
that the amount of pension payable to the surviving spouse must not be less than 60% of the
pension paid to the member while we are both alive.
We understand that we may waive the right to the joint and survivor pension provided by
section 44 of the Ontario Pension Benefits Act by signing this waiver.
We understand that by signing this waiver, the surviving spouse will not be entitled to any
joint and survivor pension provided by section 44 of the Ontario Pension Benefits Act.
We hereby waive our right to a joint and survivor pension provided by section 44 of the Ontario
Pension Benefits Act by signing this waiver in the presence of a witness.
We understand that we may cancel this waiver at any time before the date of the
commencement of payment of the member’s pension.
Dated this day of ,
Signature of witness Signature of member
Name and address of witness (printed)
Signature of witness Signature of spouse
Name and address of witness (printed)
Personal information
Waiver of Joint andSurvivor Pension
yyyy mm dd
SIN* or Ontario Teachers’ Account Number ___ ___ ___ ___ ___ ___ ___ ___ ___
Name last first middle
email address
Telephone home Telephone work
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b) I will keep my account number and password confidential. I will not share my account
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