CF-FC 2005—Service Buyback Form for Transfer Value Service

Protected "B" when completed

Privacy notice

Provision of the personal information is required pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of administrating the Canadian Forces Superannuation Act (CFSA). Refusal to provide the personal information, or the provision of incorrect information may result in loss of benefits and/or delays in processing incorrect pension estimates, benefits, or statements. Personal information is protected, and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 – Federal Pension Administration. Under the Act, individuals have a right of access to their personal information and request correction, if erroneous or incomplete.

Note

This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.

Plan member's personal information

Preferred language

Carefully read instructions on page 3 before completing this form

To be completed by the plan member
Retain a copy for your records and forward the original by registered mail to:

Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
PO Box 9500
Matane QC
G4W 0H3

Note: The Government of Canada Pension Centre will only reinstate the most recent period(s) of pensionable service corresponding to the amount received.

Important: "Payment method" see number 3 on the instructions page.

Reinstatement Choice
  • and/or the following period of service:  Years and  Days.

Agreement

I hereby choose to pay to reinstate past transfer value in a lump sum payment. If the amount received is less than the full cost required to reinstate the full previous transfer value service, then I agree that only a portion of the service will be reinstated.

I understand that, if the lump sum paid is greater than the contribution required, a refund will be made.

Date Mailed Link to footnote 1

Instructions to the Plan Member

  1. Completion of Form

    Care should be taken when completing this form since, under most circumstances, a service buyback is a binding, irrevocable agreement. Please ensure that the dates of the service which you enter are complete and accurate. If you have received more than one transfer value payment then the service of the most recent transfer value must be purchased in its entirety first.

  2. Forwarding of Form

    You must sign and forward your service buyback within one year from the date of issue of the "Notification of Plan Membership" (CF-FC 2018) that you have received.

    The completed service buyback form must be forwarded to the following address:

    Government of Canada Pension Centre - Mail Facility
    150 Dion Boulevard
    PO Box 9500 
    Matane QC G4W 0H3

  3. Payment Method

    Only payments received within 90 days of the date the service buyback is received by the Minister will be accepted and used to calculate the pensionable service that can be reinstated.

  4. Past Service Pension Adjustment (PSPA)

    A PSPA must be calculated for all buybacks with post-1989 service. Where the Canada Revenue Agency (CRA) does not approve the PSPA, the service buyback will be declared invalid.

For office use only

CF-FC 2005E (2015-03-001)

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