CF-FC 2441—Request for Eligibility Review Canadian Forces Superannuation Act

Protected "B" when completed

Privacy notice

Provision of the personal information is required pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of administrating the Canadian Forces Superannuation Act (CFSA). Refusal to provide the personal information, or the provision of incorrect information may result in loss of benefits and/or delays in processing incorrect pension estimates, benefits, or statements. Personal information is protected, and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 – Federal Pension Administration. Under the Act, individuals have a right of access to their personal information and request correction, if erroneous or incomplete.

Plan member's personal information

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Part 1—Election Information (Completed by Member)

  1. Request a review/re-calculation of eligibility to:
  2. , I disagree with this date for the following reason: (Choose one)


  1. Source documentation is required to support your request. Examples of source documents are: Pay Account info (not originals), Attendance Records, Peoplesoft/MPRR (see Pension website for a checklist of source documentation)
  2. Invalid eligibility determination resulting from missing service/earnings or deemed service/earnings in the pay system should be referred to your unit pay office for validation and processing

Part 2—Eligibility Review (completed by Government of Canada Pension Centre)

  1. A review of your Eligibility date has been completed. Members' eligibility date to:

Attached is the verification of your period of qualifying service

Part 3—Correction Action (completed by Government of Canada Pension Centre)

Canadian Forces Superannuation Act Reserve Force—Request for Eligibility Review Annex

Type of Service Start Date Cease Date Total Days Paid Unit

For office use only

CF-FC 2441E (2015-02-001)

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