(a) Give the following information (for the period indicated below) about each person or agency who contributed to the claimant's support. For example, we lock your child’s age when your application is received. See the lock in dates by immigration or category. For “Claimant’s Address”, indicate a trustee’s address where the death proceeds should be delivered. This system may contain U.S. Government information, which is restricted to authorized users ONLY. However, if a claimant was not eligible to receive benefits for a particular disease in the RSP, then that claimant may seek compensation from Class 7. For example, if a claimant was an Other Registrant in the RSP, the only disease option she was eligible for was Disease Option 2 (called Long Term Benefits). Q. WARNING. You need to indicate the name of the trust under “Claimant’s Name”. The trust name should include the date of the trust. What claimant information for a trust do I include on the Claimant’s Statement? This is called the lock in date. When we process your child’s application, we use the age on lock in date to see if your child qualifies as a dependant. ... LAST NAME) RELATIONSHIP TO CLAIMANT RELATIONSHIP TO WAGE EARNER OR SELF-EMPLOYED PERSON PRINT NAME OF CLAIMANT 1. STATEMENT REGARDING CONTRIBUTIONS. The Claimant [date] If the witness statement is made for a company which is say the second defendant in the case, it would read like this: I believe that the facts stated in this witness statement are true. Lock-in dates vary depending on your immigration program or category. Q.

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