Internet for Good for Seniors Application Form

Step 1: Please complete the form below and ensure that the details entered match those on your Old Age Security document, called the T4A(OAS) form. We will review and respond to applications within one week. If your application is approved, you will be emailed a verification code and further instructions on how to order your phone if desired and sign up for the plan.

Step 2: Upload your T4A(OAS) form. To protect your privacy, black out the first 5 digits of your SIN and OAS numbers on your T4A(OAS), leaving only the last 4 digits visible. Please ensure that the last 4 digits, as well as your name, address and contents of Box 21 are clearly visible.

You will be required to upload your T4A(OAS) form in Step 2 of this application. Click here to view a sample T4A(OAS).

Step 3: Please finish your application by clicking the Submit button.

Please note that the following fields must match with the T4A(OAS) Notice you have.

Full Name

City

Province

Last 4 digits of your SIN

T4A(OAS) Box 21 amount ("Net Supplements Paid")

Tax Year

Email address

Confirm Email address

Preferred language of communication

I will upload my T4A(OAS) in the next step and confirm that I have blacked out the first five digits of my SIN number and have left only the last four digits visible

By continuing to use this form, you consent to allowing the collection and use of the information entered above. Please click the Next button to accept and continue your application.

Collected and retained information will be used for determining eligibility for the Internet for Good for Seniors offer. Retained records will be purged within a maximum of 7 years from the date of entry and in some cases immediately. Please don’t share any sensitive information in the form outside the requested information. Sensitive information includes personal and confidential information. The definition of personal information can be found at our TELUS Privacy Commitment