Affidavits
OSFI Form 1: Attestation Regarding Withdrawal Based on Financial Hardship
Free template from Minute Notary, an Ontario notary office. The sworn attestation the owner of a federally regulated locked-in plan gives their financial institution to unlock money for financial hardship: low income, high medical or disability-related costs, or both. Prepare the wording and worksheet here; OSFI's own Form 1 is what you sign.
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Also known as
- federal financial hardship unlocking form
- locked-in RRSP hardship withdrawal
- LIF financial hardship withdrawal form
+2 more names
- PBSR Schedule V Form 1
- OSFI hardship attestation
The blanks fill themselves in as you type.
- Scope
- General template, not legal advice
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OSFI Form 1: Attestation Regarding Withdrawal Based on Financial Hardship
A compact preview of this template
01Your financial institution and plans
Name of your financial institution
Your full name
What are you asking to withdraw money for?
ATTESTATION REGARDING WITHDRAWAL BASED ON FINANCIAL HARDSHIP
OSFI Form 1, Schedule V, Pension Benefits Standards Regulations, 1985
To: ______
Federally regulated locked-in plans held by that institution from which I intend to withdraw or transfer money:
• ______, account number ______
I, ______, of ______, in the city of ______, in the province of ______, MAKE OATH AND SAY:
I am the owner of the federally regulated locked-in plans listed above.
On the day I sign this attestation, I ask to withdraw money from those plans on the basis of ______.
During this calendar year I have made no other withdrawal under paragraph 20(1)(d), 20.1(1)(m), 20.2(1)(e) or 20.3(1)(m) of the Pension Benefits Standards Regulations, 1985, apart from any withdrawal made in the 30 days before this application.
The amounts in the worksheet below are true to the best of my knowledge.
Amount sought for withdrawal (item 4 worksheet)
Line | Description | Amount |
A | My expected income for this calendar year, worked out under the Income Tax Act | $______ |
B | Total financial hardship withdrawals I have already made this calendar year from all my federally regulated locked-in plans | $______ |
B(i) | Part of B withdrawn because of low income | $______ |
B(ii) | Part of B withdrawn because of medical or disability-related costs | $______ |
C | Half of the Year's Maximum Pensionable Earnings as defined in the Pension Benefits Standards Act, 1985 | $______ |
Maximum withdrawal and amount sought
F(i) | D plus E (0 for a component I am not seeking) | $______ |
F(ii) | C minus B | $______ |
F(iii) = F | Maximum eligible withdrawal: the lower of F(i) and F(ii) | $______ |
G | Amount I ask to withdraw: F or less | $______ |
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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Overview
About this document
- 01
What is a financial hardship attestation (OSFI Form 1)?
It is your sworn statement of the facts that allow a hardship withdrawal, followed by your own calculation of how much you may take out. You rely on one ground or on both: a low income, or high costs for medical or disability-related needs.
These forms cover federally regulated locked-in money only: a locked-in RRSP, a life income fund (LIF), a restricted life income fund (RLIF) or a restricted locked-in savings plan (RLSP) holding money that came from a pension plan under the Pension Benefits Standards Act, 1985. That means the plans of employers in banking, telecommunications, interprovincial transportation and other federal undertakings. Money moved from the federal public service pension plan into a locked-in RRSP, LIF or RLIF follows the same rules.
An Ontario LIRA or LIF that came from an Ontario employer's plan follows FSRA's forms instead, and those need no commissioner. Your account statement or your institution tells you which rules apply.
- 02
When you need one
When you want money out of a federal locked-in plan because of financial hardship. The money can be paid to you in cash or moved to an RRSP or RRIF, subject to the income tax rules.
- Low income: the most you can unlock slides from half of the Year's Maximum Pensionable Earnings (YMPE) when you expect no income this year down to nothing once your expected income reaches 75% of the YMPE.
- Medical or disability-related costs: the costs you expect this year must come to at least 20% of the income you expect, and a physician must certify that the treatment or adaptive technology is required. You can unlock up to those costs, capped at half of the YMPE.
- For withdrawals up to December 31, 2026, the Year's Maximum Pensionable Earnings (YMPE) is $74,600, so half of it is $37,300 and 75% of it is $55,950. The figure changes every January, and the current year's Form 1 instructions give the current amounts.
- A second hardship withdrawal in the same calendar year must be made within 30 days of the first. OSFI's instructions say the 30 days cannot be extended.
- Form 2 goes with every Form 1.
- 03
What to include
Have your account statements and last year's tax return in front of you:
- The name of the institution and each federal locked-in plan there that you want to withdraw from, with its account number.
- Your name, street address, city and province.
- The ground you rely on: low income, high medical or disability-related costs, or the two together.
- Worksheet lines A to G. The worksheet is your own arithmetic: OSFI's FAQ says the Regulations do not require the institution to verify your figures.
- For a medical withdrawal, the physician's letter you attach and the costs you expect.
- 04
Official source and who accepts it
Your financial institution requires OSFI's own Form 1. Get it from the institution or download it from OSFI, copy the wording you prepared on this page onto it, and swear or affirm it before a notary public, commissioner or other person authorized to take affidavits. This page prepares the wording only; it does not replace the official form. Use the form and instructions for the year you apply: the YMPE figures change.
Send the sworn form to the institution that holds the account, never to OSFI or the Government. The institution decides whether you qualify and processes the request; OSFI does not approve or review individual forms.
OSFI's FAQ says the role of the notary or commissioner "is to verify and witness the individual's signature, not to verify the contents". Our notary does not decide whether you qualify, does not calculate the amount and does not advise your spouse or common-law partner. Money taken out of a locked-in plan may lose the protection from creditors that the Pension Benefits Standards Act, 1985 gives it, and it may be taxable. The forms themselves say you may need professional advice.
- 05
Common mistakes
Watch for these:
- Using household income. Line A is your own pre-tax net income for the calendar year.
- Leaving out income that counts: a hardship withdrawal already made this year goes in line A and line B, and OSFI's FAQ says payments from a LIF or RLIF count in expected income too.
- Using last year's YMPE figures for a withdrawal this year.
- Leaving out Form 2, or the physician's letter for a medical withdrawal.
- Using these forms for an Ontario LIRA or LIF, which follows FSRA's forms.
- Signing the form before the appointment instead of in front of the notary.
- 06
How to get it notarized in Ontario
Fill in the form on this page to prepare your wording, then copy it onto OSFI's official form, from your financial institution or from OSFI's website. Do not sign it yet: the attestation is sworn or affirmed in front of a notary public or commissioner for taking affidavits.
When you are ready, book an appointment with Minute Notary and bring the official form filled in but unsigned, with your photo ID. The attestation can be sworn or affirmed before our notary by video across Ontario, or in person on a mobile visit. Ask your financial institution first whether it accepts an attestation sworn by video.
Good to know
Before you fill it in.
Short notes on this template. Worth a minute before you start.
- 01
Prepared for use in Ontario. A general template, not legal advice.
- 02
Notarize online by video across Ontario, or in person anywhere in Ontario.
- 03
Sign in front of the notary, who administers your oath or affirmation and applies the seal.
Official sources
Related
- OSFI Form 2: Attestation Regarding Spouse or Common-Law Partner
- OSFI Form 3: Attestation of Total Amount Held in Locked-in Plans
- Affidavit of life certificate (proof of life for a pension)
- Guide: Unlocking a LIRA in Ontario: Forms, Spousal Consent and Who Signs
- Browse all legal templates
- Book a notarization appointment
Frequently asked
Questions about the OSFI Form 1: Attestation Regarding Withdrawal Based on Financial Hardship
- Can I swear Form 1 by video?
- Yes. The attestation can be sworn or affirmed before our notary by video across Ontario, or in person. Ask your financial institution first whether it accepts an attestation sworn by video.
- Do I need Form 2 as well?
- Yes. OSFI's instructions say a hardship withdrawal needs Form 2 too. On it you swear whether you have a spouse or common-law partner, and if you do, that person swears their own consent on the same form.
- Does the notary check my figures?
- No. The notary confirms who you are and administers your oath or affirmation. Whether you qualify and how much you can take out are for your financial institution to decide.
- Can I make more than one hardship withdrawal in a year?
- Yes, but any second withdrawal in the same calendar year must be made within 30 days of the first, and the 30 days cannot be extended. Lines B, B(i) and B(ii) record what you have already taken out this year.
- Does the physician have to be Canadian?
- Not if you live outside Canada, according to OSFI's FAQ. The letter must say that the medical or disability-related treatment or adaptive technology is required.
- Is my account federal or Ontario?
- Check your statement or ask the institution. Money from the pension plan of a federally regulated employer, such as a bank, a telecommunications company or an interprovincial carrier, uses these OSFI forms. Money from an Ontario employer's plan uses FSRA's forms, which need no commissioner. Our guide to unlocking a LIRA in Ontario compares the two.
Keep exploring
Related templates
Other documents for banks, insurers, employers & pensions.
- 01OSFI Form 2: Attestation Regarding Spouse or Common-Law Partner
The sworn attestation in which the owner of a federally regulated locked-in plan tells their financial institution whether they have a spouse or common-law partner, with that person's own sworn consent when they do. Prepare the wording here; OSFI's own Form 2 is what you sign.
Fill it out - 02OSFI Form 3: Attestation of Total Amount Held in Federally Regulated Locked-in Plans
The sworn attestation in which the owner of federally regulated locked-in plans states their total value, so the whole small balance can be withdrawn or transferred at 55 or older. Prepare the wording here; OSFI's own Form 3 is what you sign.
Fill it out - 03Statutory Declaration of Financial Hardship
A sworn declaration describing your financial circumstances — used to support a request for a fee waiver, payment arrangement, or other relief. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out - 04Statutory Declaration of Employment and Income
A sworn declaration confirming your employment and income — used as proof of income for housing, credit, or a program that asks for a sworn statement when standard documents are unavailable. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
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