CFSA 103—Canadian Forces Superannuation Act
Election to Surrender Annuity or Annual Allowance under Public Service Superannuation Act or Royal Canadian Mounted Police Superannuation Act

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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

(This election must be completed and forwarded to a commanding officer or other person designated by the Minister within the prescribed time limit.)

Part I—Election and Plan of Payment

  1. I, , , , , hereby elect pursuant to subsection 46(2) of the Canadian Forces Superannuation Act (CFSA), to surrender my right to an annuity or annual allowance under (indicate by clicking the appropriate block):

    in respect of my pensionable service as described in the said subsection; and I understand that in so electing I, or any person to whom any benefit might otherwise have become payable under the above Act, in respect of such service, will cease to be entitled to any benefit thereunder.

  2. I will pay any amount remaining unpaid for the above service in the following manner (choose only ONE plan of payment and indicate choice by clicking the appropriate block):
    the balance to be paid in monthly instalments of commencing the first day of the month following the month in which this election is made and continuing until the total arrears of contributions and interest are fully paid; OR
    commencing the first day of the month following the month in which this election is made and continuing until the total arrears of contributions and interest are fully paid;and I understand that the above plan of payment, upon verification of the total arrears of contributions, is subject to adjustment in accordance with the Canadian Forces Superannuation Regulations.
SignedLink to footnote 1 (and forwarded) at
Witnessed as to signature of contributor by

A further election on Form CFSA 100 (Election to Pay for Prior Pensionable Service) will be required, within the time prescribed by the CFSA, for any other prior elective pensionable service that the contributor wishes to count.)

Part II—Forwarding of Election

  1. The circumstances of the forwarding of the above election having been ascertained, I am satisfied that it was (indicate by clicking the appropriate block):
    , day of ,

    a date subsequent to one year of the elector having become a contributor under the CFSA.

The completed application and supporting documents are to be returned to:

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

For office use only

CFSA 103 (2014-11-001)

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