Forms

Information: Publiservice Disclaimer

This information is only accessible to federal government employees, and only to federal departments and agencies.

Attention:

If you cannot access these forms please contact your Compensation Advisor

Pay Forms

The table below contains a list of Pay forms from Public Works and Government Services Canada
Form No. Form Name
110
Fillable
PWGSC-TPSGC 110 - Contributor System - Correction Request (For Public Service Dental Care Plan Only) - This information is only accessible to federal government employees, and only to federal departments and agencies.
380
Fillable
PWGSC-TPSGC 380 - Form 1- Election For Prior Sessions - This information is only accessible to federal government employees, and only to federal departments and agencies.
395
Fillable
Public Service Management Insurance Plan - Judges Entitled to Government-paid Coverage - This information is only accessible to federal government employees, and only to federal departments and agencies.
397
Fillable
Public Service Management Insurance Plan - Judges Entitled to Government-paid Coverage Upon Inception Date - This information is only accessible to federal government employees, and only to federal departments and agencies.
398 PWGSC-TPSGC 398 - Public Service Management Insurance Plan Post-Retirement Life Insurance Certificate Of Insurance Judges Plan - This information is only accessible to federal government employees, and only to federal departments and agencies.
399
Fillable
PSMIP - Public Service Management Insurance Plan / Judges - This information is only accessible to federal government employees, and only to federal departments and agencies.
400
Fillable
PWGSC-TPSGC 400 - Public Service Management Insurance Plan Certificate Of Insurance Judges Plan - This information is only accessible to federal government employees, and only to federal departments and agencies.
426
Fillable
PWGSC-TPSGC 426 - Form 5 - Election To Contribute On Additional Remuneration Received During Prior Sessions - This information is only accessible to federal government employees, and only to federal departments and agencies.
435
Fillable
PWGSC-TPSGC 435 - Form 3 - Election Under Subsection 9 (2) - This information is only accessible to federal government employees, and only to federal departments and agencies.
446-1E
Fillable
PWGSC-TPSGC 446-1E - Public Service Pay Centre - Pay Action Request Form - This information is only accessible to federal government employees, and only to federal departments and agencies.
446-2E
Fillable
PWGSC-TPSGC 446-2E - Public Service Pay Centre - Bulk Pay Action Request Form - This information is only accessible to federal government employees, and only to federal departments and agencies.
535
Fillable
PWGSC-TPSGC 535 - Undertaking and Indemnity - This information is only accessible to federal government employees, and only to federal departments and agencies.
536
Fillable
PWGSC-TPSGC 536 - Undertaking and Indemnity - This information is only accessible to federal government employees, and only to federal departments and agencies.
540 PWGSC-TPSGC 540 - Affidavit - This information is only accessible to federal government employees, and only to federal departments and agencies.
570
Fillable
PWGSC-TPSGC 570 - Payment Transmittal Form
571
Fillable
PWGSC-TPSGC 571 - Enrolment Information and Acknowledgement Of Plan Membership
593
Fillable
PWGSC-TPSGC 593 - Update Employer Contact - This information is only accessible to federal government employees, and only to federal departments and agencies.
598
Fillable
PWGSC-TPSGC 598 - Dual Remuneration-Same Pay Office and Department - This information is only accessible to federal government employees, and only to federal departments and agencies.
2026
Fillable
PWGSC-TPSGC 2026 - Disability Insurance - This information is only accessible to federal government employees, and only to federal departments and agencies.
2026-1 PWGSC-TPSGC 2026-1 - Disability Insurance Part-time Employee Only - This information is only accessible to federal government employees, and only to federal departments and agencies.
2027 PWGSC-TPSGC 2027 - Long-term Disability Insurance - Public Service Management Insurance Plan
2027-1 PWGSC-TPSGC 2027-1 - Long-term Disability Insurance - Public Service Management Insurance Plan
2028 PWGSC-TPSGC 2028 - Public Service Management Insurance Plan - This site is only accessible to federal government employees, and only to federal departments and agencies.
2028-1
Fillable
PWGSC-TPSGC 2028-1 - Public Service Management Insurance Plan
2028-5 PWGSC-TPSGC 2028-5 - Public Service Management Insurance Plan
2028-7 Public Service Management Insurance Plan - Members Entitled to Government-Paid Coverage - This site is only accessible to federal government employees, and only to federal departments and agencies.
2028-8
Fillable
PWGSC-TPSGC 2028-8 - Public Service Health Care Plan (PSHCP) Application for Designation of Additional Dependant for Comprehensive Coverage - This information is only accessible to federal government employees, and only to federal departments and agencies.
2029
Fillable
PWGSC-TPSGC 2029 - PSMIP Certificate of Insurance - This information is only accessible to federal government employees, and only to federal departments and agencies.
2029-1
Fillable
PWGSC-TPSGC 2029-1 - PSMIP Certificate of Insurance Members Entitled to Employer-Paid Coverage - This information is only accessible to federal government employees, and only to federal departments and agencies.
2032
Fillable
PWGSC-TPSGC 2032 - Statutory Declaration (Public Service Superannuation Act) - This information is only accessible to federal government employees, and only to federal departments and agencies.
2033
Fillable
PWGSC-TPSGC 2033 - Request to Deposit Public Service Pension Cheques in a Financial Institution - This information is only accessible to federal government employees, and only to federal departments and agencies.
2066
Fillable
PWGSC-TPSGC 2066 - Surrender of Rights Under a Canadian Government Annuity Contract - This information is only accessible to federal government employees, and only to federal departments and agencies.
2073
Fillable
PWGSC-TPSGC 2073 - CFSA/RCMPSA Report Of Pensionable Service - This information is only accessible to federal government employees, and only to federal departments and agencies.
2074
Fillable
PWGSC-TPSGC 2074 - Authorization for Payment of Debt to The Crown - This information is only accessible to federal government employees, and only to federal departments and agencies.
2081
Fillable
PWGSC-TPSGC 2081 - Evidence of Medical Examination - This information is only accessible to federal government employees, and only to federal departments and agencies.
2221
Fillable
PWGSC-TPSGC 2221 - Notice to Repay Pension of Canadian Forces, RCMP or Members of Parliament - This information is only accessible to federal government employees, and only to federal departments and agencies.
2229
Fillable
PWGSC-TPSGC 2229 - Confidential Questionnaire - Employee Group Insurance, Declaration of Personal Insurability - This information is only accessible to federal government employees, and only to federal departments and agencies.
2232
Fillable
PWGSC-TPSGC 2232 - Certificate of Entitlement - This information is only accessible to federal government employees, and only to federal departments and agencies.
2268
Fillable
PWGSC-TPSGC 2268 - Release Authorization - This information is only accessible to federal government employees, and only to federal departments and agencies.
2278
Fillable
PWGSC-TPSGC 2278 - Contribution Remittance For Period of Leave Without Pay (PSHCP) - This information is only accessible to federal government employees, and only to federal departments and agencies.
2278-1
Fillable
PWGSC-TPSGC 2278-1 - Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay - This information is only accessible to federal government employees, and only to federal departments and agencies.
2347-19 PWGSC-TPSGC 2347-19 - Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay - This information is only accessible to federal government employees, and only to federal departments and agencies.
2397
Fillable
PWGSC-TPSGC 2397 - Notice of Cancellation - Public Service Health Care Plan (PSHCP) - This information is only accessible to federal government employees, and only to federal departments and agencies.
2451
Fillable
PWGSC-TPSGC 2451 - Post-Retirement Life Insurance Plan - This information is only accessible to federal government employees, and only to federal departments and agencies.
2451-2
Fillable
PWGSC-TPSGC 2451-2 - Post-Retirement Life Insurance Plan - Certificate of Insurance Members Entitled to Employer-Paid Coverage - This information is only accessible to federal government employees, and only to federal departments and agencies.
2471
Fillable
PWGSC-TPSGC 2471 - Certification of Operational Service - Correctional Service of Canada - This information is only accessible to federal government employees, and only to federal departments and agencies.
2472
Fillable
PWGSC-TPSGC 2472 - Estimate Request and Information Release Authorization for Reciprocal Transfer Agreement Purposes - This information is only accessible to federal government employees, and only to federal departments and agencies.
2476
Fillable
PWGSC-TPSGC 2476 - Request for Estimate of Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage after Retirement - This information is only accessible to federal government employees, and only to federal departments and agencies.
2477
Fillable
PWGSC-TPSGC 2477 - Election for Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage After Retirement - This information is only accessible to federal government employees, and only to federal departments and agencies.
2485
Fillable
PWGSC-TPSGC 2485 - Request for Division of Members of Parliament pension benefits in accordance with the Pension Benefits Division Act - This information is only accessible to federal government employees, and only to federal departments and agencies.
2487
Fillable
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 - This information is only accessible to federal government employees, and only to federal departments and agencies.
2493
Fillable
PWGSC-TPSGC 2493 - Confirmation of Information - Pension Benefits Division - This information is only accessible to federal government employees, and only to federal departments and agencies.
2517-1
Fillable
PWGSC-TPSGC 2517-1 - Personnel - Pay Input Form - This information is only accessible to federal government employees, and only to federal departments and agencies.
2584
Fillable
PWGSC-TPSGC 2584 - Union Deductions - Dues and Insurance - This information is only accessible to federal government employees, and only to federal departments and agencies.
4002
Fillable
PWGSC-TPSGC 4002 - Production Control Requisition - This information is only accessible to federal government employees, and only to federal departments and agencies.
4023
Fillable
PWGSC-TPSGC 4023 - Payroll Transfer Journal Voucher - This information is only accessible to federal government employees, and only to federal departments and agencies.
4142 PWGSC-TPSGC 4142 - Pension Deductions (Members of Parliament) - This information is only accessible to federal government employees, and only to federal departments and agencies.
4144
Fillable
PWGSC-TPSGC 4144 - Withdrawal Allowance - This information is only accessible to federal government employees, and only to federal departments and agencies.
4168
Fillable
PWGSC-TPSGC 4168 - Notice of Termination and Option for Benefit - This information is only accessible to federal government employees, and only to federal departments and agencies.
4170
Fillable
PWGSC-TPSGC 4170 - Eligibility to Contribute - This information is only accessible to federal government employees, and only to federal departments and agencies.
4175 PWGSC-TPSGC 4175 - Members of Parliament Retiring Allowance Act - This information is only accessible to federal government employees, and only to federal departments and agencies.
5136
Fillable
PWGSC-TPSGC 5136 - Security Request - This information is only accessible to federal government employees, and only to federal departments and agencies.
8432-2
Fillable
PWGSC-TPSGC 8432-2 - Direct Deposit - Intercept or Recall Request - Pay - This information is only accessible to federal government employees, and only to federal departments and agencies.
8437
Fillable
PWGSC-TPSGC 8437 - Direct Deposit Enrolment Request - This information is only accessible to federal government employees, and only to federal departments and agencies.
8882-4
Fillable
PWGSC-TPSGC 8882-4 - Common Architecture Security Request - This information is only accessible to federal government employees, and only to federal departments and agencies.
GC 136 PWGSC-TPSGC GC 136 - Specimen Signature - This information is only accessible to federal government employees, and only to federal departments and agencies.

Pensioner Forms

The table below contains a list of Pensioner forms from Public Works and Government Services Canada
Form No. Form Name
481 E
Fillable
PWGSC-TPSGC 481 - Public Service Health Care Plan (PSHCP) Relief Provision Application Form
577
Fillable
PWGSC-TPSGC 577 - Plan Member Contact Information
1422
Fillable
PWGSC-TPSGC 1422 - Deductions From Annuity or Annual Allowance
2002
Fillable
PWGSC-TPSGC 2002 - Declaration of Attendance at an Educational Institute
2012
Fillable
PWGSC-TPSGC 2012 - Interpretation Of Medical Examination For Pension Purposes
2016
Fillable
PWGSC-TPSGC 2016 - Statutory Declaration
2017
Fillable
PWGSC-TPSGC 2017 - Election To Continue As A Participant Under The Supplementary Death Benefit (SDB) Plan
2020
Fillable
PWGSC-TPSGC 2020 - Confirmation of Salary and Service
2040
Fillable
PWGSC-TPSGC 2040 - Statutory Declaration (Public Service Superannuation Act Administration)
2196
Fillable
PWGSC-TPSGC 2196 - Naming or Substitution of a Beneficiary
2223
Fillable
PWGSC-TPSGC 2223 - Supplementary Death Benefit Claim Form
2265
Fillable
PWGSC-TPSGC 2265 - Pension Information Release
2451-1
Fillable
PWGSC-TPSGC 2451-1 - Post-retirement Life Insurance Plan - Change of Name/Beneficiary
2460
Fillable
PWGSC-TPSGC 2460 - Application for Diversion from a Public Service Pension
2480
Fillable
PWGSC-TPSGC 2480 - Election Not To Count Leave Without Pay As Pensionable Service
2483
Fillable
PWGSC-TPSGC 2483 - Statutory Declaration
2484
Fillable
PWGSC-TPSGC 2484 - Statutory Declaration
2486
Fillable
PWGSC-TPSGC 2486 - Application for Division of a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act
2488
Fillable
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

Employer Support Services Forms

The table below contains a list of Employer Support Services forms from Public Works and Government Services Canada
Form No. Form Name
571
Fillable
PWGSC-TPSGC 571 - Enrolment Information and Acknowledgement Of Plan Membership
577
Fillable
PWGSC-TPSGC 577 - Plan Member Contact Information
591
Fillable
PWGSC-TPSGC 591 - Employer Representative User ID Request - This site is only accessible to federal government employees, and only to federal departments and agencies.
1422
Fillable
PWGSC-TPSGC 1422 - Deductions from Annuity or Annual Allowance
1871
Fillable
PWGSC-TPSGC 1871 - Default Notice
2001
Fillable
PWGSC-TPSGC 2001 - Elective Non-Contributory Pensionable Service Record
2001-1
Fillable
PWGSC-TPSGC 2001-1 - Elective Pensionable Service Record for Operational Service
2005
Fillable
PWGSC-TPSGC 2005 - Service Buy back Form For Transfer Value Service - This site is only accessible to federal government employees, and only to federal departments and agencies.
2010
Fillable
PWGSC-TPSGC 2010 - Statutory Declaration
2014
Fillable
PWGSC-TPSGC 2014 - Notification of Death In Service
2041-1
Fillable
PWGSC-TPSGC 2041-1 - Election to Reduce Benefit to $10,000 - Form A
2069
Fillable
PWGSC-TPSGC 2069 - Pensionable Employment Questionnaire - This site is only accessible to federal government employees, and only to federal departments and agencies.
2092
Fillable
PWGSC-TPSGC 2092 - Surrender of Benefits - This site is only accessible to federal government employees, and only to federal departments and agencies.
2123
Fillable
PWGSC-TPSGC 2123 - Certification of Leave Without Pay
2201
Fillable
PWGSC-TPSGC 2201 - Request to Certify a Salary Rate - This site is only accessible to federal government employees, and only to federal departments and agencies.
2270
Fillable
PWGSC-TPSGC 2270 - Notice to Start Service Buy back Deductions - This site is only accessible to federal government employees, and only to federal departments and agencies.
2292
Fillable
PWGSC-TPSGC 2292 - Monthly Remittance of Superannuation Contributions (Public Service Corporation) - This site is only accessible to federal government employees, and only to federal departments and agencies.
2302
Fillable
PWGSC-TPSGC 2302 - Information Request - Canada Pension Plan Or Quebec Pension Plan - This information is only accessible to federal government employees, and only to federal departments and agencies.
2347-18
Fillable
PWGSC-TPSGC 2347-18 - Certification of Lock-In For Purposes of the Public Service Superannuation Act or the Pension Benefits Division Act
2386
Fillable
PWGSC-TPSGC 2386 - Termination/Retirement Information - This site is only accessible to federal government employees, and only to federal departments and agencies.
2429
Fillable
PWGSC-TPSGC 2429 - Pension Reduction Waiver Request - This site is only accessible to federal government employees, and only to federal departments and agencies.
2429-1
Fillable
PWGSC-TPSGC 2429-1 - Pension Reduction Waiver Request - This site is only accessible to federal government employees, and only to federal departments and agencies.
2467
Fillable
PWGSC-TPSGC 2467 - Statutory Declaration
2467-1
Fillable
PWGSC-TPSGC 2467-1 - Statutory Declaration
2469 PWGSC-TPSGC 2469 - Election to Continue to Pay Extra Contributions for all Additional Years of Non-Operational Service - This site is only accessible to federal government employees, and only to federal departments and agencies.
2719
Fillable
PWGSC-TPSGC 2719 - Compensation Client Address
3006
Fillable
PWGSC-TPSGC 3006 - Service Buy back Form - This site is only accessible to federal government employees, and only to federal departments and agencies.
8638
Fillable
PWGSC-TPSGC 8638 - Cash Receipts Register
8756
Fillable
PWGSC-TPSGC 8756 - Requisition for Interdepartmental Settlement

Obsolete Forms

The table below contains a list of Obsolete forms
Form No. Form Name
51 Certification and Reconciliation of Superannuation Contributions
(January 2005) (declared obsolete)
61-03 Pension Adjustment Reversal (PAR)
(January 2004) (declared obsolete)
2004 Personal Documentation Certification Form
(May 2008) (declared obsolete)
2007 Requisition for Payment - Supplementary Death Benefits
(December 2009) (declared obsolete)
2008 Determination of Payee for Return of Contributions - Deceased Contributor with Less than Two Years Pensionable Service
(December 2009) (declared obsolete)
2008-1 Determination of Eligible Survivors - Deceased Contributor with Two or More Years Pensionable Service
(December 2009) (declared obsolete)
2011 Notice of Termination and Option for Benefit - Employees with Two or More Years of Pensionable Service
(December 2009) (declared obsolete)
2011-1 Reason for Termination and Option for Benefit Air Traffic Controllers (ATC) Operational Service
(May 2004) (declared obsolete)
2011-2 Option for Benefit - Operational Service, Correctional Service Canada
(August 2010) (declared obsolete)
2011-3 Notice of Termination and Option for Benefit - Employees with Less than Two Years of Pensionable Service
(December 2009) (declared obsolete)
2013 Screening Form for Public Service Corporations - Public Service Superannuation Act
(December 2009) (declared obsolete)
2015 Form Letter - Acknowledgement of Receipt of Your Request
(August 2005) (declared obsolete)
2018 Notification of Plan Membership
(December 2009) (declared obsolete)
2019 Notice of 35 Years of Pensionable Service
(May 2010) (declared obsolete)
2030 Request for Estimate of Service Buyback Paid to Date for Transfer Value
(December 2009) (declared obsolet
2031 Request for Estimate - Transfer Value
(December 2009) (declared obsolete)
2037 Form Letter - Locating of Pension Cheques
(August 2004) (declared obsolete)
2053-1 Tax Credit Input Form
(February 2005) (declared obsolete)
2055 PBDA Information Request Worksheet
(June 2004) (declared obsolete)
2055-1 PBDA Information Request Worksheet - Public Service Corporations/Operational Service
(July 2000) (declared obsolete)
2057 Estimate of Cost for a Service Buyback
(December 2009) (declared obsolete)
2068 Arrears of Payment Calculation
(December 2009) (declared obsolete)
2075 Request for documents
(August 2010) (declared obsolete)
2075-1 Request for documents
(December 2009) (declared obsolete)
2077 Details of Transfer under a Reciprocal Agreement
(December 2009) (declared obsolete)
2090-1 Disposal of Dormant Files Under the Public Service Superannuation Act Administration
(April 2002) (declared obsolete)
2093 Form Letter - Requesting Additional Information to Positively Identify a Person (contributor)
(May 2004) (declared obsolete)
2093-1 Form Letter - Requesting Additional Information to Positively Identify a Person
(July 2004) (declared obsolete)
2096 Supplementary Death Benefit Control
(December 2009) (declared obsolete)
2097 Service Buyback Notice
(December 2009) (declared obsolete)
2120 Employment or Termination Advice
(June 2004) (declared obsolete)
2170 Supplementary Death Benefit - Notice Of Payment Due
(December 2009) (declared obsolete)
2171 Statement of Earnings - Deceased Pensioner
(May 2010) (declared obsolete)
2219 Superannuation Directorate - Production Control File Relocation System
(August 2002) (declared obsolete)
2219-2 Production Control File Location System
(May 2005) (declared obsolete)
2241 Superannuation Documentation Transmittal Slip
(September 2009) (declared obsolete)
2268-1 Form Letter - Pensionable Employment With
(December 2009) (declared obsolete)
2276 Contributor System - TOS - Screening
(September 2003) (declared obsolete)
2287 Control Notice
(April 2004) (declared obsolete)
2321 Termination and Contributions Advice
(December 2009) (declared obsolete)
2343 Contributor System - Public Service Corporations Annual Pro Forma
(October 1997) (declared obsolete)
2347 Form Letter - Request for Screening Documents
(February 2004) (declared obsolete)
2348 Form Letter - Acknowledgment of Retirement
(May 2006) (declared obsolete)
2355 Form Letter - Beneficiary Card Invalid
(March 2006) (declared obsolete)
2355-1 Form Letter - Designation of Beneficiary Card
(June 2004) (declared obsolete)
2355-3 Form Letter - Naming or Substitution of a Beneficiary
(August 2004) (declared obsolete)
2355-4 Form Letter - Invalid Naming or Substitution of Beneficiary
(November 2004) (declared obsolete)
2364 Daily Cheque Listing
(April 1999) (declared obsolete)
2388 Form Letter - Outstanding Cheque
(June 2005) (declared obsolete)
2432 Call Back Control Form
(March 2005) (declared obsolete)
2437 Client Inquiry - Survivors Case Checklist
(December 2009) (declared obsolete)
2439-4 Contributor Identification Card
(October 2003) (declared obsolete)
2459 Proof of Contributor Effective Date
(November 2004) (declared obsolete)
2468 Application for Certification of a Provisional Past Service Pension Adjustment
(November 2009) (declared obsolete)
2478 Election to Become a Contributor to the Public Service Pension Plan
(October 2004) (declared obsolete)
2482 Transfer Service Record
(December 2009) (declared obsolete)
2577 Request for Return of Superannuation Contributions
December 2009) (declared obsolete)

Other Forms