PWGSC-TPSGC 2460 - Application for Diversion from a Public Service Pension

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Application for Diversion from a Public Service Pension in Accordance with Part II of the "Garnishment, Attachment and Pension Diversion Act"

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 pension diversion. This personal information will be stored in Personal Information Bank Number PWGSC PCE 702 and will be protected, used and disclosed in accordance with the Privacy Act. Under the 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 that you provide about another individual may be accessible to that person under the 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.

Plan Member's Personal Information

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Please provide the following information concerning the recipient of the pension benefit.

Most recent known and most recent known year at this address

Most recent place of employment in the Public Service and most recent year at that place (if known)

Check the applicable acts or regulations under which the recipient is entitled to a pension (if known)

Please provide any other information which may help to identify the recipient.

Please provide the following information concerning the applicant (the person named in the court order as being entitled to financial support).

Will the applicant have custody and control of another person entitled to financial support from the recipient?

If yes, please indicate name and address.

Will the applicant have someone acting on his/her behalf (e.g. a lawyer)?

If yes, please indicate full name, and address, and their legal relationship.

Is this form being completed by the acting person?

Diversion payment made to a person other than the applicant (e.g. family court). Identify the person named in the financial support order.

Documentation

The original or certified true copy of the financial support order under which this application is made must be attached.

If the name on the financial support order is not the same as the name of the applicant (identified on the previous page), then you must provide either:

  1. a certified copy of the certificate evidencing the change where a formal change of name has occurred
    or
  2. a statutory declaration by the person making this application as to the circumstances concerning the difference in any other case.

If the name on the financial support order is the same as the name of the applicant (identified on the previous page) and this person is a child then you must provide:

  1. a child birth certificate
    or
  2. a certified true copy of proof of birth

Authorization

I hereby request the Minister of Public Works and Government Services Canada to divert from the recipient's net pension benefit an amount calculated in accordance with the provisions of the "Garnishment, Attachment and Pension Diversion Act" and Regulations.

Signature of Applicant or Representative:

Note: Mail the completed application to:

Departmental General Counsel
Public Works and Government Services Canada
Phase III, 1C2, Place du Portage
Gatineau QC K1A 0S5

For Office Use Only

PWGSC-TPSGC 2460 (09/2009)