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.
Plan member's personal information
Carefully read instructinos before completing
The information provided is collected under the authority of Treasury Board for the administration of the Canadian Forces Superannuation Act. The completion of this form is mandatory if you wish to designate a beneficiary under Part II of the Canadian Forces Superannuation Act. All information is protected under the provisions of the Privacy Act. The information will be banked in your Personal Pension File. Access to this information is controlled by the Custodian of the Pension File, the Director Canadian Forces Pensions Services (DCFPS).
I hereby appoint the following beneficiary and revoke any previous designation
Note: You must be a participant in the Supplementary Death Benefit (SDB) plan to complete this form; otherwise, the form will be invalid. You may cancel or change your beneficiary at any time while a participant, whether serving or retired.
Upon your death, your named beneficiary may become entitled to certain lump sum benefits which are payable under Part I of the Canadian Forces superannuation Act. A naming takes effect the date this form is completed; however, this form must be received by the Government of Canada Pension Centre prior to your death. Therefore, it is recommended that the completed form, be forwarded by express mail to the address indicated below.
Important—You may only have one designated beneficiary at a time.
You may designate:
- any person over 18 years of age on the date of naming
- your Estate (print "Estate" in the space provided for the beneficiary). If you only wish to cancel the
previous designation and not name a new beneficiary, simply print "Estate"
- any registered charitable, benevolent/religious or educational organization or institution (name,
address and registration number of the institution are required)
- An ineligible or ambiguous designation will render the form invalid
Instructions—Completion of the Form
Complete all unshaded areas. Please print.
Service Number or Pension Number must be provided.
Amendments are not acceptable unless initialed by the participant and the witness.
Both the participant and the witness must sign this form in dark ink.
Forwarding of the Form
It is important that this form be received at the address indicated below as soon as possible.
Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
Post Office (PO) Box 9500
Matane QC G4W 0H3
It is recommended that you forward this form by express mail
No ackowledgement receipt will be sent. Please retain a copy for your records.