Canadian Armed Forces Military Personnel Instruction 01/17 – Annexes – Imposed Restriction
Annexes
- Annex A – Sample - Memo For Requesting for Imposed Restriction Status
- Annex B – Forms - Imposed Restriction Status Questionnaire (Regular Force & Reserve Force Class C Members, and Service Couple)
- Annex C – Sample - Memo Request for Imposed Restriction Status Be Lifted
- Annex D – Sample - Memo Request for Imposed Restriction Status Be Extended Beyond Five Years
- Annex E – Sample - Memo Experienced a Change in Imposed Restriction Status (Circumstances)
Annex A – Sample – Memo For Requesting Imposed Restriction Status
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5600-1 ([Last 3 digits of S/N, Surname])
[Date]
Distribution List
REQUEST FOR IMPOSED RESTRICTION (IR) STATUS
Ref: CAFMPI 01/17 Imposed Restriction
- I, [Rank] [Initials] [Surname] [Last 3 digits of S/N] as indicated at reference, request Imposed Restriction status from [date] to [date] for the following reasons: [List reasons] (in order to be eligible for Separation Expense benefits).
- Attached is completed Annex B: Form – Imposed Restriction (IR) Status Questionnaire to be forwarded to my delegated authority, [Name/Posn Title of Delegated Authority].
- For review and consideration.
[Initials] [Surname]
[Rank]
[Position/Title]
[loc]
Encl: 1
Distribution List
Action
[IR Delegated Authority]
IR Section
CO
CM
Info
Member
CAN PROTECTED B
Annex B – Imposed Restriction Status Questionnaire
Appendix 1 – Imposed Restriction Status Questionnaire – Regular Force & Reserve Class C
Appendix 2 – Imposed Restriction Status Questionnaire – Service Couple
Annex C – Sample - Memo Request for Imposed Restriction Status Be Lifted
CAN PROTECTED B
5600-1 ([Last 3 digits of S/N, Surname])
[Date]
Distribution List
REQUEST FOR IMPOSED RESTRICTION
(IR) STATUS BE LIFTED
Ref: CAFMPI 01/17 - Imposed Restriction
- I, [Rank] [Initials] [Surname] [Last 3 digits of S/N] as indicated at reference, request that my Imposed Restriction status from [date] to [date] be lifted for the following reason(s): [List reasons] (in order to cease Separation Expense benefits).
- For your review and consideration.
[Initials] [Surname]
[Rank]
[Position/Title]
[loc]
Encl: 1
Distribution List
Action
[IR Delegated Authority]
IR Section
CO
CM
Info
Member
CAN PROTECTED B
Annex D – Sample - Memo Request for Imposed Restriction Status Be Extended Beyond Five Years
CAN PROTECTED B
5600-1 ([Last 3 digits of S/N, Surname])
[Date]
Distribution List
REQUEST FOR IMPOSED RESTRICTION (IR)
STATUS BE EXTENDED BEYOND FIVE YEARS
Ref: CAFMPI 01/17 - Imposed Restriction
- I, [Rank] [Initials] [Surname] [Last 3 digits of S/N] as indicated at reference, request that my Imposed Restriction status be extended beyond five years from [date] to [date] for the following reasons: [List reasons] (in order to be eligible for Separation Expense benefits).
- Attached is Annex B: Form – Imposed Restriction (IR) Status Questionnaire to be forwarded to my delegated authority, [Name of Delegated Authority]
- For review and consideration.
[Initials] [Surname]
[Rank]
[Position/Title]
[loc]
Encl: 1
Distribution List
Action
[IR Delegated Authority]
IR Section
CO
CM
Info
Member
CAN PROTECTED B
Annex E – Memorandum Template - Request for Imposed Restriction
CAN PROTECTED B
5600-1 ([Last 3 digits of S/N, Surname])
[Date]
Distribution List
CHANGE IN IMPOSED RESTRICTION STATUS (IR)
Ref: CAFMPI 01/17, Imposed Restriction
- I, [Rank] [Initials] [Last Name] [Last 3 digits of S/N] as indicated in the reference, request a change in my IR status. The following changes have occurred that may affect my eligibility for separation benefits: [List changes]
- For review and consideration.
[Initials]
[Surname] [Rank]
[Position/Title]
[loc]
Distribution List Action
[IR Delegated Authority]
IR Section
CO
CM
Info
Member
CAN PROTECTED B