Application and Declaration for Low-Income Seniors Benefit 2019

To qualify for the $400 annual benefit applicants must have been a resident of New Brunswick on December 31, 2018 and a recipient of a benefit under the Old Age Security Act (Canada), notably:
  • The Federal Guaranteed Income Supplement (GIS) during 2018 (must be 65 years or older) or
  • the Federal Allowance for the Survivor during 2018 (must be between 60-64 years old) or
  • the Federal Allowance during 2018 (must be between 60-64 years old).
Important: Persons in receipt of a Federal allowance who are under the age of 60 do not qualify for this benefit.

Where both spouses received the guaranteed income supplement and lived in the same household, only one payment is available.
Application deadline date: December 31, 2019

* Required fields
* First Name
Middle Name
* Last Name
Mailing Address:
* Postal Code:
Search Address works for Canadian postal codes only
* Civic Number:
* Street Name:
Street Type:
Apartment/Unit Number:
* Community / Town / City:
* Province:  For addresses outside of Canada put NA
* Country:
* Telephone Number:  Ex: 5064538654
* Date of Birth  Example: 2005-01-31
* Social Insurance Number  9 Digits
* Preferred Language for Correspondence   
* Please indicate the federal benefits that you received in 2018:
* Guaranteed Income Supplement (GIS) (must be 65 years or older)   
* Allowance for the Survivor (must be between 60-64 years old)   
* Allowance (must be between 60-64 years old)   
* Were you a resident of New Brunswick on December 31, 2018?   
* Do you reside with your spouse?      
Spouse's Name:
Spouse's Social Insurance Number  9 Digits
The personal information on this form is being collected under the authority of the New Brunswick Income Tax Act, and will be used for the purposes of determining eligibility under the Low-Income Seniors’ Benefit, and for necessary administration of this Program. If you have any questions regarding the collection and use of this information, please contact the Manager Tax Accounting, Department of Finance, P. O. Box 1900, Fredericton, NB E3B 5G4. Phone: 1-800-669-7070 or e-mail
I declare the above information to be correct and I authorize Employment and Social Development Canada to verify this information. I recognize that an application must be submitted by December 31, 2019. *
Typing in your name and electronically sending this form to the Department of Finance constitutes your electronic signature

Ex: 5064538654
* Signature of Applicant / Representative * Telephone
* Date (Example: 2005-01-31)