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  1. You can choose to view the Hyper-Text Markup Language (HTML) or Portable Document Format (PDF) versions of forms on this page. Some forms are fillable, in that you can type information onto the form as it is displayed on your screen and then print it, or you may save a blank copy of the form to your computer. Filled-in forms cannot be saved.
  2. Fillable forms are marked with an asterisk *.
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Form No. HTML Format Other Formats Date
110 Public Works and Government Services Canada (PWGSC)- Travaux publics et Services gouvernementaux Canada (TPSGC) 110 - Contributor System - Correction Request (For Insurance Purposes Only) * 110 PDF  356K B
(Help on File Formats)		 June 2011
140 PWGSC- TPSGC 140 - Notification of Rehabilitation Leave, Education Leave (with allowance) or Dual Employment - same pay office, same department * 140 PDF  240K B
(Help on File Formats)		 May 2011
380 PWGSC- TPSGC 380 - Form 1- Election For Prior Sessions * 380 PDF  218K B
(Help on File Formats)		 April 2006
398 PWGSC- TPSGC 398 - Public Service Management Insurance Plan Post-Retirement Life Insurance Certificate Of Insurance Judges Plan 398 PDF  35K B
(Help on File Formats)		 August 2005
400 PWGSC- TPSGC 400 - Public Service Management Insurance Plan Certificate Of Insurance Judges Plan * 400 PDF  39K B
(Help on File Formats)		 August 2005
426 PWGSC- TPSGC 426 - Form 5 - Election To Contribute On Additional Remuneration Received During Prior Sessions * 426 PDF  298K B
(Help on File Formats)		 May 2006
435 PWGSC- TPSGC 435 - Form 3 - Election Under Subsection 9 (2) * 435 PDF  292K B
(Help on File Formats)		 November 2005
463-05 PWGSC- TPSGC 463-05 - Description of the RL-Slip Data File   August 2010
535 PWGSC- TPSGC 535 - Undertaking and Indemnity * 535 PDF  39K B
(Help on File Formats)		 March 2008
536 PWGSC- TPSGC 536 - Undertaking and Indemnity 536 PDF  220K B
(Help on File Formats)		 March 2011
540 PWGSC- TPSGC 540 - Affidavit 540 PDF  16K B
(Help on File Formats)		 April 1998
570 PWGSC- TPSGC 570 - Payment Transmittal Form * 570 PDF  128K B
(Help on File Formats)		 April 2011
571 PWGSC- TPSGC 571 - Enrolment Information and Acknowledgement Of Plan Membership 571 PDF  235K B
(Help on File Formats)		 December 2009
577 PWGSC- TPSGC 577 - Plan Member Contact Information 577 PDF  123K B
(Help on File Formats)		 December 2009
591 PWGSC- TPSGC 591 - Employer Representative User ID Request * 591 PDF  139K B
(Help on File Formats)		 January 2010
593 PWGSC- TPSGC 593 - Update Employer Contact * 593 PDF  145K B
(Help on File Formats)		 January 2010
598 PWGSC- TPSGC 598 - Dual Remuneration-Same Pay Office and Department * 598 PDF  429K B
(Help on File Formats)		 January 2010
1422 PWGSC- TPSGC 1422 - Deductions from Annuity or Annual Allowance * 1422 PDF  169K B
(Help on File Formats)		 December 2009
1871 PWGSC- TPSGC 1871 - Default Notice * 1871 PDF  269K B
(Help on File Formats)		 March 2010
2001 PWGSC- TPSGC 2001 - Elective Non-Contributory Pensionable Service Record * 2001 PDF  169K B
(Help on File Formats)		 September 2009
2001-1 PWGSC- TPSGC 2001-1 - Elective Pensionable Service Record for Operational Service 2001-1 * PDF  169K B
(Help on File Formats)		 September 2009
2002 PWGSC- TPSGC 2002 - Declaration of Attendance at an Educational Institute * 2002 PDF  192K B
(Help on File Formats)		 September 2009
2005 PWGSC- TPSGC 2005 - Service Buy back Form For Transfer Value Service * 2005 PDF  145K B
(Help on File Formats)		 September 2009
2010 PWGSC- TPSGC 2010 - Statutory Declaration * 2010 PDF  182K B
(Help on File Formats)		 October 2004
2014 PWGSC- TPSGC 2014 - Notification of Death In Service * 2014 PDF  142K B
(Help on File Formats)		 May 2011
2016 PWGSC- TPSGC 2016 - Statutory Declaration * 2016 PDF  46K B
(Help on File Formats)		 September 2009
2017 PWGSC- TPSGC 2017 - Election To Continue As A Participant Under The Supplementary Death Benefit (SDB) Plan * 2017 PDF  143K B
(Help on File Formats)		 December 2009
2020 PWGSC- TPSGC 2020 - Confirmation of Salary and Service * 2020 PDF  328K B
(Help on File Formats)		 December 2009
2026 PWGSC- TPSGC 2026 - Disability Insurance * 2026 PDF  45K B
(Help on File Formats)		 February 1999
2026-1 PWGSC- TPSGC 2026-1 - Disability Insurance Part-time Employee Only 2026-1 PDF  16K B
(Help on File Formats)		 October 1999
2027 PWGSC- TPSGC 2027 - Long-term Disability Insurance - Public Service Management Insurance Plan 2027 PDF  20K B
(Help on File Formats)		 December 2002
2027-1 PWGSC- TPSGC 2027-1 - Long-term Disability Insurance - Public Service Management Insurance Plan (Part-time Employee Only) 2027-1 PDF  19K B
(Help on File Formats)		 December 1998
2028 PWGSC- TPSGC 2028 - Public Service Management Insurance Plan 2028 PDF  22K B
(Help on File Formats)		 December 2002
2028-1 PWGSC- TPSGC 2028-1 - Public Service Management Insurance Plan * 2028-1 PDF  177K B
(Help on File Formats)		 November 2002
2028-3 PWGSC- TPSGC 2028-3 - Public Service Management Insurance Plan - Declaration of Health   March 2006
2028-5 PWGSC- TPSGC 2028-5 - Public Service Management Insurance Plan (PART-TIME EMPLOYEE ONLY) 2028-5 PDF  18K B
(Help on File Formats)		 March 2000
2028-7 PWGSC- TPSGC 2028-7 - Public Service Management Insurance Plan - Members Entitled to Government-Paid Coverage 2028-7 PDF  25K B
(Help on File Formats)		 September 1995
2028-8 PWGSC- TPSGC 2028-8 - Public Service Health Care Plan (PSHCP) Application for Designation of Additional Dependant for Comprehensive Coverage * 2028-8 PDF  126K B
(Help on File Formats)		 June 2006
2029 PWGSC- TPSGC 2029 - PSMIP Certificate of Insurance * 2029 PDF  41K B
(Help on File Formats)		 August 2005
2029-1 PWGSC- TPSGC 2029-1 - PSMIP Certificate of Insurance Members Entitled to Employer-Paid Coverage * 2029-1 PDF  29K B
(Help on File Formats)		 June 2005
2032 PWGSC- TPSGC 2032 - Statutory Declaration (Public Service Superannuation Act) * 2032 PDF  40K B
(Help on File Formats)		 September 2009
2033 PWGSC- TPSGC 2033 - Request to Deposit Public Service Pension Cheques in a Financial Institution * 2033 PDF  158K B
(Help on File Formats)		 November 2009
2040 PWGSC- TPSGC 2040 - Statutory Declaration (Public Service Superannuation Act Administration) * 2040 PDF  268K B
(Help on File Formats)		 February 2010
2041-1 PWGSC- TPSGC 2041-1 - Election to Reduce Benefit to $10,000 - Form A * 2041-1 PDF  135K B
(Help on File Formats)		 September 2009
2066 PWGSC- TPSGC 2066 - Instructions Regarding the Surrender of Rights Under a Canadian Government Annuity Contract * 2066 PDF  94K B
(Help on File Formats)		 September 2009
2069 PWGSC- TPSGC 2069 - Pensionable Employment Questionnaire * 2069 PDF  239K B
(Help on File Formats)		 September 2009
2073 PWGSC- TPSGC 2073 - CFSA/RCMPSA Report Of Pensionable Service * 2073 PDF  321K B
(Help on File Formats)		 January 2010
2074 PWGSC- TPSGC 2074 - Authorization for Payment of Debt to The Crown * 2074 PDF  216K B
(Help on File Formats)		 December 2009
2081 PWGSC- TPSGC 2081 - Evidence of Medical Examination * 2081 PDF  134K B
(Help on File Formats)		 September 2009
2092 PWGSC- TPSGC 2092 - Surrender of Benefits * 2092 PDF  173K B
(Help on File Formats)		 September 2009
2123 PWGSC- TPSGC 2123 - Certification of Leave Without Pay (for prior contributory service) * 2123 PDF  211K B
(Help on File Formats)		 September 2009
2196 PWGSC- TPSGC 2196 - Naming or Substitution of a Beneficiary * 2196 PDF  160K B
(Help on File Formats)		 September 2009
2201 PWGSC- TPSGC 2201 - Request to Certify a Salary Rate * 2201 PDF  138K B
(Help on File Formats)		 September 2009
2221 PWGSC- TPSGC 2221 - Notice to Repay Pension of Canadian Forces, RCMP or Members of Parliament * 2221 PDF  168K B
(Help on File Formats)		 September 2009
2223 PWGSC- TPSGC 2223 - Supplementary Death Benefit Claim Form * 2223 PDF  134K B
(Help on File Formats)		 September 2009
2229 PWGSC- TPSGC 2229 - Confidential Questionnaire - Employee Group Insurance, Declaration of Personal Insurability * 2229 PDF  109K B
(Help on File Formats)		 November 2009
2232 PWGSC- TPSGC 2232 - Certificate of Entitlement * 2232 PDF  50K B
(Help on File Formats)		 July 2009
2265 PWGSC- TPSGC 2265 - Pension Information Release * 2265 PDF  148K B
(Help on File Formats)		 January 2010
2268 PWGSC- TPSGC 2268 - Release Authorization * 2268 PDF  131K B
(Help on File Formats)		 September 2009
2270 PWGSC- TPSGC 2270 - Notice to Start Service Buy back Deductions * 2270 PDF  42K B
(Help on File Formats)		 September 2009
2278 PWGSC- TPSGC 2278 - Contribution Remittance For Period of Leave Without Pay (PSHCP) * 2278 PDF  338K B
(Help on File Formats)		 April 2010
2278-1 PWGSC- TPSGC 2278-1 - Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay * 2278-1 PDF  84K B
(Help on File Formats)		 June 2004
2302 PWGSC- TPSGC 2302 - Information Request - Canada Pension Plan Or Quebec Pension Plan * 2302 PDF  138K B
(Help on File Formats)		 September 2009
2347-18 PWGSC- TPSGC 2347-18 - Certification of Lock-In For Purposes of the Public Service Superannuation Act or the Pension Benefits Division Act * 2347-18 PDF  145K B
(Help on File Formats)		 April 2010
2347-19 PWGSC- TPSGC 2347-19 - Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay 2347-19 PDF  67K B
(Help on File Formats)		 January 2004
2386 PWGSC- TPSGC 2386 - Termination / Retirement Information * 2386 PDF  335K B
(Help on File Formats)		 June 2011
2397 PWGSC- TPSGC 2397 - Notice of Cancellation - Public Service Health Care Plan (PSHCP) * 2397 PDF  137K B
(Help on File Formats)		 May 2010
2429 PWGSC- TPSGC 2429 - Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is the employer) * 2429 PDF  131K B
(Help on File Formats)		 December 2009
2429-1 PWGSC- TPSGC 2429-1 - Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is not the employer) * 2429-1 PDF  138K B
(Help on File Formats)		 December 2009
2451 PWGSC- TPSGC 2451 - Post-Retirement Life Insurance Plan * 2451 PDF  73K B
(Help on File Formats)		 February 2005
2451-1 PWGSC- TPSGC 2451-1 - Post-retirement Life Insurance Plan - Change of Name/Beneficiary * 2451-1 PDF  40K B
(Help on File Formats)		 October 2011
2451-2 PWGSC- TPSGC 2451-2 - Post-Retirement Life Insurance Plan - Certificate of Insurance Members Entitled to Employer-Paid Coverage * 2451-2 PDF  28K B
(Help on File Formats)		 August 2005
2460 PWGSC- TPSGC 2460 - Application for Diversion from a Public Service Pension * 2460 PDF  222K B
(Help on File Formats)		 September 2009
2467 PWGSC- TPSGC 2467 - Statutory Declaration - Claimant's Statement * 2467 PDF  100K B
(Help on File Formats)		 August 2010
2467-1 PWGSC- TPSGC 2467-1 - Statutory Declaration - Supporting Statement * 2467-1 PDF  94K B
(Help on File Formats)		 August 2010
2469 PWGSC- TPSGC 2469 - Election to Continue to Pay Extra Contributions for all Additional Years of Non-Operational Service 2469 PDF  20K B
(Help on File Formats)		 March 2000
2471 PWGSC- TPSGC 2471 - Certification of Operational Service - Correctional Service of Canada * 2471 PDF  282K B
(Help on File Formats)		 September 2009
2472 PWGSC- TPSGC 2472 - Estimate Request and Information Release Authorization for Reciprocal Transfer Agreement Purposes * 2472 PDF  139K B
(Help on File Formats)		 September 2009
2476 PWGSC- TPSGC 2476 - Request for Estimate of Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage after Retirement * 2476 PDF  138K B
(Help on File Formats)		 September 2009
2477 PWGSC- TPSGC 2477 - Election for Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage After Retirement * 2477 PDF  181K B
(Help on File Formats)		 September 2009
2480 PWGSC- TPSGC 2480 - Election Not To Count Leave Without Pay As Pensionable Service * 2480 PDF  131K B
(Help on File Formats)		 April 2011
2483 PWGSC- TPSGC 2483 - Statutory Declaration - In the Matter of Provision of Pension Benefits Information under the Pension Benefits Division Act * 2483 PDF  157K B
(Help on File Formats)		 September 2009
2484 PWGSC- TPSGC 2484 - Statutory Declaration - In the matter of an Application for Division of Pension Benefits under the Pension Benefits Division Act * 2484 PDF  631K B
(Help on File Formats)		 September 2009
2485 PWGSC- TPSGC 2485 - Request for Division of Members of Parliament pension benefits in accordance with the Pension Benefits Division Act * 2485 PDF  53K B
(Help on File Formats)		 February 2009
2486 PWGSC- TPSGC 2486 - Application for Division of a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act * 2486 PDF  174K B
(Help on File Formats)		 September 2009
2487 PWGSC- TPSGC 2487 - Request for Pension Benefits Division Information with Respect to Members of Parliament Pension Benefits in Accordance with the Pension Benefits Division Act * 2487 PDF  56K B
(Help on File Formats)		 January 2009
2488 PWGSC- TPSGC 2488 - Request for Pension Benefits Division Information with respect to a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act * 2488 PDF  254K B
(Help on File Formats)		 January 2009
2493 PWGSC- TPSGC 2493 - Confirmation of Information - Pension Benefits Division * 2493 PDF  606K B
(Help on File Formats)		 April 2011
2517-1 PWGSC- TPSGC 2517-1 - Personnel - Pay Input Form * 2517-1 PDF  88K B
(Help on File Formats)		 March 2005
2546 PWGSC- TPSGC 2546 - Personnel - Pay Input Transmittal and Batch Control Form 2546 PDF  24K B
(Help on File Formats)		 October 2000
2549 PWGSC- TPSGC 2549 - Personal - Pay Input and Time Summary Form 2549 PDF  38K B
(Help on File Formats)		 October 1997
2551 PWGSC- TPSGC 2551 - Correction Form - Personnel - Pay Data 2551 PDF  18K B
(Help on File Formats)		 June 1998
2579 PWGSC- TPSGC 2579 - Pay System Problem Report - Observation 2579 PDF  18K B
(Help on File Formats)		 December 1999
2584 PWGSC- TPSGC 2584 - Union Deductions - Dues and Insurance 2584 PDF  18K B
(Help on File Formats)		 December 2004
2595 PWGSC- TPSGC 2595 - Application for the Refund of PSAC Dues * 2595 PDF  46K B
(Help on File Formats)		 March 2006
2719 PWGSC- TPSGC 2719 - Compensation Client Address * 2719 PDF  23K B
(Help on File Formats)		 October 2001
3006 PWGSC- TPSGC 3006 - Service Buy back Form * 3006 PDF  191K B
(Help on File Formats)		 September 2009
4002 PWGSC- TPSGC 4002 - Production Control Requisition * 4002 PDF  46K B
(Help on File Formats)		 November 2004
4023 PWGSC- TPSGC 4023 - Payroll Transfer Journal Voucher * 4023 PDF  42K B
(Help on File Formats)		 July 2006
4142 PWGSC- TPSGC 4142 - Pension Deductions (Members of Parliament) * 4142 PDF  31K B
(Help on File Formats)		 October 2004
4144 PWGSC- TPSGC 4144 - Withdrawal Allowance (Members of Parliament) * 4144 PDF  283K B
(Help on File Formats)		 August 2005
4168 PWGSC- TPSGC 4168 - Notice of Termination and Option for Benefit * 4168 PDF  212K B
(Help on File Formats)		 November 2004
4170 PWGSC- TPSGC 4170 - Eligibility to Contribute * 4170 PDF  262K B
(Help on File Formats)		 December 2004
4175 PWGSC- TPSGC 4175 - Members of Parliament Retiring Allowance Act * 4175 PDF  30K B
(Help on File Formats)		 December 2004
5136 PWGSC- TPSGC 5136 - Security Request * 5136 PDF  80K B
(Help on File Formats)		 August 2008
7631 PWGSC- TPSGC 7631 - Isolated Posts and Government Housing * 7631 PDF  43K B
(Help on File Formats)		 October 2003
7631-1 PWGSC- TPSGC 7631-1 - Isolated Posts and Government Housing * 7631-1 PDF  72K B
(Help on File Formats)		 March 2004
8432-2 PWGSC- TPSGC 8432-2 - Direct Deposit - Intercept or Recall Request - Pay * 8432-2 PDF  200K B
(Help on File Formats)		 May 2005
8437 PWGSC- TPSGC 8437 - Direct Deposit Enrolment Request * 8437 PDF  309K B
(Help on File Formats)		 June 2009
8638 PWGSC- TPSGC 8638 - Cash Receipts Register 8638 PDF  15K B
(Help on File Formats)		 May 1995
8756 PWGSC- TPSGC 8756 - Requisition for Interdepartmental Settlement 8756 PDF  18K B
(Help on File Formats)		 December 1996
8882-4 PWGSC- TPSGC 8882-4 - Common Architecture Security Request * 8882-4 PDF  867K B
(Help on File Formats)		 May 2008
GC136 PWGSC- TPSGC GC136 - Common-Law Partner Declaration - Isolated Posts and Government Housing Directive (IPGHD) GC136 PDF  33K B
(Help on File Formats)		 September 1988
Date Modified: 2012-01-10

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