Public Works and Government Services Canada
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Forms - Alphabetical Listing
Notice
The forms listed below are available in an Adobe Portable Document Format (PDF). To view and print these documents, you need to have Adobe Reader installed on your system. The Department of Public Works and Government Services Canada continues to work toward completing the transition to its CLF 2.0 compliant Web site. If the following forms are not accessible to you and you would like assistance, please contact us. A PWGSC employee will respond to your request within one business day and ensure you get the assistance required.
Notes:
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- Form Name Form No.
-
A
-
Accounts Reconciliation
(April 1996)(PDF 10K ) 8240-1 -
Affidavit
(April 1998)(PDF 11K ) 540 -
Application for Certification of a Provisional Past Service Pension Adjustment
(December 2009)(PDF 458K ) 2468 -
Application for Diversion from a Public Service Pension
(December 2009)(PDF 303K ) 2460 -
Application for Division of a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act
(December 2009)(PDF 257K ) 2486 * -
Application for the Refund of PSAC Dues
(March 2006) (PDF 271K ) 2595 * -
Arrears of Payment Calculation
(December 2009)(PDF 278K ) 2068 * -
C
-
Call Back Control Form
(March 2005)(PDF 389K ) 2432 * -
Cash Receipts Register
(May 1995)(PDF 8.8K ) 8638 -
Central Accounting Journal Voucher
(February 2005)(PDF 134K ) 1849 -
Certificate of Entitlement
(July 2009)(PDF 69K ) 2232 * -
Certification and Reconciliation of Superannuation Contributions
(January 2005)(PDF 451K ) 51 * -
Certification Notice - Pension Support System
(September 2009) (PDF 528K ) 2386 * -
Certification of Leave Without Pay (for prior contributory service)
(December 2009)(PDF 293K ) 2123 * -
Certification of Lock-in for Purposes of the Public Service Superannuation Act or the Pension Benefits Division Act
(December 2009)(PDF 225K ) 2347-18 * -
Certification of Lock-In for Purposes of the Members of Parliament Retiring Allowance Act or the Pension Benefits Division Act
(January 2004) (PDF 148K ) 2347-19 -
Certification of Operational Service - Correctional Service of Canada
(December 2009)(PDF 364K ) 2471 * -
Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is not the employer)
(December 2009)(PDF 208K ) 2429-1 -
Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is the employer)
(March 2005)(PDF 272K ) 2429 * -
CFSA/RCMPSA Report of Pensionable Service
(December 2009)(PDF 327K ) 2073 * -
Cheque Issue List Summary
(June 1996)(PDF 11K ) 7456 -
Client Inquiry - Survivors Case Checklist
(December 2009)(PDF 195K ) 2437 * -
Common Architecture Security Request
(October 2006)(PDF 513K ) 8882-4 * -
Common-Law Partner Declaration - Isolated Posts and Government Housing Directive (IPGHD)
(March 2004)(PDF 150K ) 7631-1 -
Compensation Client Address
(October 2001)(PDF 145K ) 2719 * -
Confidential Questionnaire - Employee Group Insurance, Declaration of Personal Insurability
(November 2009) (PDF 102K ) 2229 -
Contributor Identification Card
(October 2003) (PDF 70K ) 2439-4 -
Contribution Remittance for Period of Leave Without Pay (Public Service Health Care Plan - PSHCP)
(July 2009)(PDF 379K ) 2278 * -
Contributor System - Correction Request
(December 2009) (PDF 457K ) 110 * -
Contributor System - Public Service Corporations Annual Pro Forma
(October 1997)(PDF 37K ) 2343 -
Contributor System - TOS - Screening
(September 2003)(PDF 407K ) 2276 * -
Control Notice
(April 2004)(PDF 65K ) 2287 -
Correction Form - Personnel - Pay Data
(June 1998) (PDF 12K ) 2551 -
D
-
Daily Cheque Listing
(April 1999)(PDF 8.2K ) 2364 -
Declaration of Attendance at an Educational Institute
(October 2004)(PDF 291K ) 2002 * -
Details of Transfer under a Reciprocal Agreement
(December 2009)(PDF 425K ) 2077 * -
Deductions from Annuity or Annual Allowance
(December 2009)(PDF 259K ) 1422 * -
Default Notice
(March 2010)(PDF 352K ) 1871 * -
Description du fichier de données des relevés
(Available in French only)
(January 2006)(PDF 126K ) 463-05 * -
Determination of Eligible Survivors - Deceased Contributor with Two or More Years of Pensionable Service
(December 2009)(PDF 266K ) 2008-1 * -
Determination of Contact Person and Amount of Supplementary Death Benefit Payment
(December 2009)(PDF 541K ) 2014 * -
Determination of Payee for Return of Contributions - Deceased Contributor with Less than Two Years Pensionable Service
(December 2009)(PDF 285K ) 2008 * -
Direct Deposit - Electronic Deposit of Your Monthly Pension Benefits
(December 2003) (PDF 119K ) 2430 -
Direct Deposit - Intercept Request - Pension
(March 2005)(PDF 309K ) 8432-1 * -
Direct Deposit - Intercept or Recall Request - Pay
(May 2005)(PDF 379K ) 8432-2 * -
Direct Deposit Enrolment Request
[Public Service Pay / RCMP Pay]
(June 2009) (PDF 742K ) 8437 * -
Disability Insurance
(February 1999)(PDF 175K ) 2026 * -
Disability Insurance - Part-time Employee Only
(October 1999)(PDF 9.6K ) 2026-1 -
Disposal of Dormant Files Under the Public Service Superannuation Act Administration
(April 2002) (PDF 6.9K ) 2090-1 -
E
-
Election for Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage After Retirement
(December 2009)(PDF 281K ) 2477 * -
Election Form for Elective Pensionable Service
(December 2009)(PDF 312K ) 3006 * -
Election Not to Count Leave Without Pay as Pensionable Service
(December 2009)(PDF 241K ) 2480 * -
Election to Become a Contributor to the Public Service Pension Plan
(October 2004)(PDF 284K ) 2478 * -
Election to Continue as Participant Under Supplementary Death Benefit (SDB) Plan
(December 2009)(PDF 220K ) 2017 * -
Election to Continue to Pay Extra Contributions for all Additional Years of Non-Operational Service
(March 2000)(PDF 14K ) 2469 -
Election To Reduce Benefit to $10,000
(December 2009)(PDF 206K ) 2041-1 * -
Elective Non-Contributory Pensionable Service Record
(December 2009)(PDF 272K ) 2001 * -
Elective Pensionable Service Record for Operational Services
(December 2009)(PDF 272K ) 2001-1 * -
Eligibility to Contribute
(December 2004)(PDF 416K ) 4170 * -
Employment or Termination Advice
(June 2004)(PDF 90K ) 2120 -
Enrolment Information and Acknowledgement of Plan Membership
(December 2009)(PDF 185K ) 571 * -
Estimate of Cost for a Service Buyback
(December 2009)(PDF 185K ) 2057 * -
Estimate Request and Information Release Authorization for Reciprocal Transfer Agreement Purposes
(December 2009)(PDF 233K ) 2472 * -
Evidence of Medical Examination
(December 2009)(PDF 209K ) 2081 * -
F
-
Form 1 - Election For Prior Sessions Members of Parliament Retiring Allowances Act
(April 2006)(PDF 216K ) 380 * - Form 3 - Election Under Subsection 9 (2), Members of Parliament Retiring Allowances Act (November 2005)(PDF 407K) 435 *
- Form 5 - Election to Contribute on Additional Remuneration Received During Prior Sessions (May 2006) (PDF 480K) 426 *
-
Form Letter - Acknowledgement of Receipt of Your Request
(August 2005)(PDF 26K) 2015 -
Form Letter - Acknowledgment of Retirement
(May 2006) (declared obsolete) 2348 -
Form Letter - Authorization for Recoveries of Debts due to the Crown
(December 2009)(PDF 300K) 2074 * -
Form Letter - Beneficiary Card Invalid
(March 2006)(PDF 168K) 2355 * -
Form Letter - Claim for Disability Insurance
(November 2009) (PDF 331K) 2203 * -
Form Letter - Claim for Long-term Disability Insurance
(November 2009)(PDF 67K) 2203-1 * -
Form Letter - Designation of Beneficiary Card
(June 2004)(PDF 129K) 2355-1 -
Form Letter - DFT, Change of Bank Account Number
(July 2004) (PDF 100K) 4033 -
Form Letter - Direct Deposit
(May 2005)(PDF 454K) 2410 * -
Form Letter - Disability Insurance Application
(November 2009)(PDF 215K) 2204 * -
Form Letter - Disability Insurance Claim
(November 2009)(PDF 234K) 2188 * -
Form Letter - Invalid Naming or Substitution of Beneficiary
(November 2004) (declared obsolete) 2355-4 -
Form Letter - Life Insurance
(June 2005) (PDF 379K) 2380 * -
Form Letter - Long-term Disability Insurance
(November 2009) (PDF 16K) 2380-1 -
Form Letter - Long Term Disability Insurance Claim
(November 2009)(PDF 181K) 2207 * -
Form Letter - Long Term Disability Insurance Claim
(November 2009)(PDF 40K) 2188-1 * -
Form Letter - Locating of Pension Cheques
(August 2004) (PDF 108K) 2037 -
Form Letter - Naming or Substitution of a Beneficiary
(August 2004)(PDF 87K) 2355-3 -
Form Letter - Outstanding Cheque
(June 2005)(PDF 354K) 2388 * -
Form Letter - Pensionable Employment With
(December 2009)(PDF 219K) 2268-1 -
Form Letter - PSMIP - Assessment of Applications More Than One Year Old
(March 2006) (PDF 84K) 2395 -
Form Letter - Request for Screening Documents
(February 2004) (PDF 111K) 2347 -
Form Letter - Requesting Additional Information to Positively Identify a Person (contributor)
(May 2004)(PDF 129K) 2093 -
Form Letter - Requesting Additional Information to Positively Identify a Person (contributor)
(July 2004)(PDF 129K) 2093-1 -
G
-
I
-
Information Request - Canada Pension Plan/Quebec Pension Plan
(December 2009) (PDF 211K) 2302 * -
Interpretation of Superannuation Medical Examination
(December 2009)(PDF 277K) 2012 * -
Isolated Posts and Government Housing
(October 2003)(PDF 103K) 7631 -
L
-
Long Term Disability Insurance - Public Service Management Insurance Plan
(December 2009)(PDF 65K) 2027 -
Long Term Disability Insurance - Public Service Management Insurance Plan (Part-time Employee Only)
(December 1998)(PDF 13K) 2027-1 -
M
-
Mainframe User ID Security Request
(November 2005)(PDF 718K) 5136 * -
Members of Parliament Retiring Allowance Act
(December 2004)(PDF 108K) 4175 -
Miscellaneous Deductions - Code 64
(December 2004)(PDF 337K) 1872 * -
Monthly Remittance of Superannuation Contributions (Public Service Corporation)
(July 2000)(PDF 31K) 2292 -
N
-
Naming or Substitution of a Beneficiary
(December 2009)(PDF 235K) 2196 * -
Notice of 35 Years of Pensionable Service
(December 2009)(PDF 313K) 2019 * -
Notice of Cancellation - Public Service Health Care Plan (PSHCP)
(November 2009)(PDF 31K) 2397 -
Notice of Termination and Option for Benefit
(November 2004)(PDF 457K) 4168 * -
Notice of Termination and Option for Benefit - Employees with Two or More Years of Pensionable Service
(December 2009)(PDF 261K) 2011 * -
Notice of Termination and Option for Benefit - Employees with Less than Two Years of Pensionable Service
(December 2009)(PDF 277K) 2011-3 * -
Notice to Repay Pension of Canadian Forces, RCMP or Members of Parliament
(December 2009)(PDF 260K) 2221 * -
Notice to Start Service Buyback Deductions
(December 2009) (PDF 393K) 2270 * -
Notification of Plan Membership
(December 2009) (PDF 262K) 2018 * -
O
-
Option for Benefit - Operational Service, Correctional Service Canada
(December 2009)(PDF 255K) 2011-2 * -
P
-
Payroll Transfer Journal Voucher
(July 2006)(PDF 319K) 4023 * -
Pay System Problem Report - Observation
(December 1999)(PDF 12K) 2579 -
PBDA Information Request Worksheet
(June 2004)(PDF 160K) 2055 -
PBDA Information Request Worksheet - Public Service Corporations/Operational Service
(July 2000)(PDF 15K) 2055-1 -
Pension Adjustment Reversal (PAR)
(December 2006)(PDF 765K) 61 * -
Pension Adjustment Reversal (PAR)
(January 2004)(PDF 110K) 61-03 -
Pension Benefits Division - Certification of Leave Without Pay
(May 2006)(PDF 446K) 2493 * -
Pension Deductions (Members of Parliament)
(October 2004)(PDF 27K) 4142 -
Pension Information Release
(December 2009)(PDF 239K) 2265 * -
Pensionable Employment Questionnaire
(December 2009)(PDF 613K) 2069 * -
Pensioners' Dental Services Plan (PDSP) Form - April 1, 2006
Pensioners Entitled to the Veterans Affairs Canada (VAC) Dental Services Program (March 2010) (PDF 217K) 437 * - Pensioners' Dental Services Plan (PDSP) Form - April 1, 2006 (March 2010) (PDF 125K) 439 *
-
Personal Documentation Certification Form
(May 2008)(declared obsolete) 2004 -
Personal - Pay Input and Time Summary Form
(October 1997)(PDF 33K) 2549 -
Personnel - Pay Input Form
(March 2005)(PDF 441K) 2517-1 * -
Personnel - Pay Input Transmittal and Batch Control Form
(October 2000)(PDF 18K) 2546 -
Plan Member Contact Information
(February 2010)(PDF 457K) 577 -
Post Age 65 Election for Elective Pensionable Service - Annuitant
(December 2009)(PDF 457K) 2473 * -
Post-Retirement Life Insurance Plan
(February 2005)(PDF 532K) 2451 * -
Post-Retirement Life Insurance Plan - Certificate of Insurance Members Entitled to Employer-Paid Coverage
(August 2005)(PDF 33K) 2451-2 * -
Production Control File Location System
(May 2005)(PDF 21K) 2219-2 -
Production Control Requisition
(November 2004)(PDF 166K) 4002 * -
Proof of Contributor Effective Date
(November 2004) (PDF 105K) 2459 -
PSMIP Certificate of Insurance
(June 2005)(PDF 47K) 2029* -
PSMIP Certificate of Insurance - Members Entitled to Employer-Paid Coverage
(June 2005)(PDF 34K) 2029-1 * -
PSSA Refund (Cash)
(September 1999)(PDF 135K) 7011 * -
Public Service Health Care Plan (PSHCP) Application for Designation of Additional Dependant for Comprehensive Coverage
(June 2006)(PDF 193K) 2028-8 * -
Public Service Management Insurance Plan
(December 2002) (PDF 70K) 2028 -
Public Service Management Insurance Plan (Change of Name or of Beneficiary)
(November 2002)(PDF 317K) 2028-1 * - Public Service Management Insurance Plan - Declaration of Health 2028-2
-
Public Service Management Insurance Plan - Members Entitled to Government-Paid Coverage
(September 1995)(PDF 20K) 2028-7 -
Public Service Management Insurance Plan - Part-time employee only
(March 2000)(PDF 12K) 2028-5 -
Public Service Management Insurance Plan
Post-Retirement Life Insurance - Certificate of Insurance
Judges Plan
(August 2005)(PDF 29K) 398 -
Public Service Management Insurance Plan (PSMIP) - Certificate of Insurance Judges Plan
(August 2005)(PDF 74K) 400 * -
Q
-
R
-
Reason for Termination and Option for Benefit Air Traffic Controllers (ATC) Operational Service
(May 2004)(PDF 345K) 2011-1 * -
Regional Pay System - Pay Office Input Form
(August 1998)(PDF 13K) 7340 -
Regional Pay System - Personnel-Pay Input Form
(August 1998)(PDF 15K) 7340-1 -
Release Authorization
(December 2009)(PDF 183K) 2268 * -
Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay
(June 2004)(PDF 355K) 2278-1 * -
Statutory Declaration
(December 2009)(PDF 84K) 2032 * -
Request for Division of Members of Parliament pension benefits in accordance with the Pension Benefits Division Act
(February 2009) (PDF 136K) 2485 * -
Request for documents
(December 2009)(PDF 385K) 2075-1 -
Request for Estimate - Transfer Value
(December 2009)(PDF 105K) 2031 * -
Request for Estimate of Service Buyback Paid to Date for Transfer Value
(December 2009)(PDF 238K) 2030 * -
Request for Estimate of Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage after Retirement
(December 2009)(PDF 213K) 2476 * -
Request for Pension Benefits Division Information with respect to a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act
(January 2009)(PDF 316K) 2488 -
Request for Pension Benefits Division Information with Respect to Members of Parliament Pension Benefits in Accordance with the Pension Benefits Division Act
(January 2009) (PDF 183K) 2487 * -
Request for Return of Superannuation Contributions
(December 2009)(PDF 312K) 2577 * -
Request for Service Records
(July 2004)(PDF 88K) 2238 -
Request for Shipping
(October 1997)(PDF 5.9K) 109 -
Request to Certify a Salary Rate
(December 2009)(PDF 237K) 2201 -
Request to Deposit Superannuation Cheques in a Financial Institution
(December 2009)(PDF 240K) 2033 * -
Requisition for Interdepartmental Settlement
(December 1996)(PDF 11K) 8756 -
Requisition for Payment - Supplementary Death Benefits
(December 2009)(PDF 492K) 2007 * -
S
-
Supplementary Death Benefit - Notice Of Payment Due
(December 2009)(PDF 383K) 2170 * -
Salary Service Information - Pension Support System
(December 2009)(PDF 869K) 2020 * -
Screening Form for Public Service Corporations - Public Service Superannuation Act
(December 2009)(PDF 268K) 2013 * -
Service Buyback Form for Transfer Value Service
(December 2009) (PDF 219K) 2005 * -
Service Buyback Notice
(December 2009)(PDF 210K) 2097 * -
Service Buyback Payment Transmittal for Plan Member on Leave Without Pay
(December 2009)(PDF 206K) 570 * -
Specimen Signature
(June 2004)(PDF 66K) GC-136 -
Statement of Earnings - Deceased Pensioner
(June 2004)(PDF 513K) 2171 * -
Statement of Option - Leave Without Pay
(March 2005)(PDF 334K) 2481 * -
Statement of Qualifying Retroactive Lump-Sum Payment (QRLSP)
(December 2006)(PDF 566K) 37 * -
Statutory Declaration
(December 2009)(PDF 84K) 2032 * -
Statutory Declaration for Common Law Relationship
(December 2009)(PDF 101K) 2016 * -
Statutory Declaration - In the matter of an Application for Division of Pension Benefits under the Pension Benefits Division Act
(December 2009)(PDF 677K) 2484 * -
Statutory Declaration - In the Matter of Provision of Pension Benefits Information under the Pension Benefits Division Act
(December 2009)(PDF 1.0M) 2483 * -
Statutory Declaration - In the Matter of the Public Service Superannuation Act
(October 2004)(PDF 1.5M) 2010 * -
Statutory Declaration - Public Service Superannuation Act Subsections 25(4), 25(4.1) and 25(10) - Claimant's Statement
(November 2007)(PDF 272K) 2467 * -
Statutory Declaration - Public Service Superannuation Act - Subsection 25(4) - Supporting Statement
(December 2009)(PDF 264K) 2467-1 * -
Statutory Declaration - Public Service Superannuation Act Administration
(March 2010)(PDF 837K) 2040 -
Superannuation Directorate - Pension and Deductions Paylist
(January 2000)(PDF 18K) 7241 -
Superannuation Directorate - Production Control File Relocation System
(August 2002)(PDF 7.5K) 2219 -
Superannuation Documentation Transmittal Slip
(December 2009)(PDF 384K) 2241 * -
Superannuation Remittance for Employees on Leave Without Pay
(December 2009)(PDF 235K) 4005 * -
Supplementary Death Benefit Control
(December 2009)(PDF 245K) 2096 -
Supplementary Death Benefit Claim Form
(December 2009)(PDF 205K) 2223 * -
Surrender of Benefits
(December 2009)(PDF 259K) 2092 * -
Surrender of Rights Under a Government Annutiy Contract
(December 2009)(PDF 144K) 2066 * -
T
-
Tax Credit Input Form
(February 2005)(PDF 25K) 2053-1 -
Termination and Contributions Advice
(December 2009) (PDF 274K) 2321 -
Training - Advance Reimbursement Request
(April 2005)(PDF 563K) 371 * -
Transfer Service Record
(December 2009)(PDF 213K) 2482 -
U
-
Undertaking and Indemnity
(August 2005)(PDF 300K) 535 * -
Undertaking and Indemnity
(February 1997)(PDF 11K) 536 -
Union Deductions - Dues and Insurance
(December 2004) (PDF 472K) 2584 * -
V
-
Void Cheques
(March 1996)( 6.1K) 7456-1 -
W
-
Withdrawal Allowance (Members of Parliament)*
(August 2005)(PDF 578K) 4144
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