Public Works and Government Services Canada
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Provision of the information requested on this document is voluntary. This information is being collected in accordance with the Public Service Superannuation Act (PSSA) for the purpose of electing not to count a period of leave without pay as pensionable service. This information will be stored in Personal Information Bank Number PWGSC PCU 702 and will be protected, used and disclosed in accordance with the Privacy Act. Under this Act, you have the right to request access to your personal information and to request corrections should you believe the information contains errors or omissions. Personal information provided about another individual may be accessible to that person under the personnels Privacy Act. The records will be retained by the department for two years following the last administrative action, and then will be destroyed.
This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.
For your period of leave without pay (LWOP) that commenced or will commence on the date indicated below, you have the option of NOT counting the period of LWOP in excess of the first three months as pensionable service.
If you elect NOT to count this period of LWOP, you will not be credited with the service and accordingly, you will not be required to pay deficiencies in pension contributions for your period of LWOP other than for the first three months.
To make an election NOT to count the period of LWOP in excess of the first three months as pensionable service, you must sign and forward this form to the Public Service Pension Centre no later than three months following your return to work.
If you do not exercise this option within three months of returning to work, deficiencies in pension contributions will be recovered for your entire period of leave without pay.
Please inform your personnel office if you were employed in the public service while you were on leave without pay.
If you are in a Dual Employment situation (working in a term position, of 12 or more hours a week, while on LWOP from your substantive position), at the end of every term position you will have the option not to count the LWOP in excess of the first three months as pensionable service by completing this form. A separate form is required at the end of each term position.
Retain a copy for your records and return the original form to the Pension Centre at the address below:
Public Service Pension Centre - Mail Facility
150 Dion Blvd.
PO Box 8000
Matane QC G4W 4T6
I hereby elect NOT to count as pensionable service the portion of my period of LWOP that is in excess of the first three months. The date on which my period of LWOP began or will
begin is indicated above.
I understand that by signing this form, ONLY the first three months of my period of LWOP will be pensionable and that I am required to pay the deficiencies for that first three month period. The balance of my LWOP will be non-pensionable.
This decision is irrevocable.
PWGSC-TPSGC 2480 (04/2011)