Endowment 150 Adult Application

Age 18-59

Endowment 150 offers eligible people with disabilities a one-time grant of $150 to help their Registered Disability Savings Plan (RDSP) grow. If eligible, this $150 deposit will attract up to $450 in government grants, for a total of $600 into your RDSP.

PLEASE COMPLETE THE APPLICATION IN FULL. ANY MISSING SECTIONS WILL RESULT IN A DELAY IN PROCESSING YOUR GRANT.

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* 1. How did you hear about the Endowment 150 grant?

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* 2. Beneficiary Name

First Name

Last Name

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* 3. Beneficiary Information

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address

Phone Number *

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* 4. Beneficiary Date of Birth

Date / Time

Date

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* 5. Beneficiary Social Insurance Number (only required if we need to submit your information to MSDPR for PWD income assistance verification)

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* 6. Holder Name (only complete this section if the RDSP beneficiary is NOT the RDSP holder)

First Name

Last Name

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* 7. Holder Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 8. Relation to Beneficiary (eg. Legal Parent, Guardian, etc.)

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* 9. Financial Institution where RDSP is held

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* 10. If your Financial Institution allows direct deposit into your RDSP, please attach either a void cheque or direct deposit form.

PDF, JPEG, JPG file types only.

Choose File

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* 11. Please attach a copy of your RDSP statement or official bank/government document clearly showing the:
- RDSP holder’s name
- The date which is within the last six months
- The term "RDSP" or "Registered Disability Savings Plan"

PLEASE MAKE SURE YOUR RDSP STATEMENT HAS THE ABOVE COMPONENTS. ANY MISSING INFORMATION WILL RESULT IN A DELAY IN PROCESSING YOUR APPLICATION. Application forms are not considered proof of your RDSP account.

PDF, JPG, JPEG file types only.

Choose File

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* 12. Please provide one of the following as proof of low income:

I have received PWD income assistance from the BC government since January 1, 2008 (Attach confirmation of assistance if you can access My SelfServe)

I have received PWD income assistance from the BC government since January 1, 2008 but do not have access to My SelfServe (it may take longer to process your application)

I have received assistance from the Indigenous Services Canada (ISC) Persons with Disabilities (PWD) Program since January 1, 2008

I have not received income assistance but have had an annual income below $34,500 in one year since 2008 (attach CRA Notice of Assessment or other official tax document showing total income) *Must include name, year, and total income*

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* 13. Upload proof of low income

PDF, JPEG, JPG file types only.

Choose File

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* 14. Disclosure: Please read carefully, and check EACH item to indicate your consent.

I certify that the information provided in this application is true, correct and complete to the best of my ability.

I certify that I have never received the E150 from any organization previously to the best of my knowledge.

I certify that upon receipt of the E150, I will deposit it into the RDSP account listed on my RDSP statement.

For auditing purposes, I understand I may be required to provide proof of this deposit to Plan Institute in the future.

I authorize Plan Institute to disclose this information to Vancouver Foundation for reporting purposes.

I authorize Plan Institute to disclose this information to MSDPR or BCANDS (if residing on first nations communities) to confirm income assistance.

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* 15. If you reside in a First Nations community, please indicate First Nation that approved your income assistance.

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* 16. If this form has been filled out by a third party on behalf of the applicant please write your name and phone number or email below:

Full Name:

Phone number or Email: