CF-FC 2483—Statutory Declaration in the matter of provision of Pension Division Benefits Information
Protected "B" when completed
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.
Complete Part 1 if you were married, and/or complete Part 2 if you resided together in a conjugal relationship or if you were married and resided together in a conjugal relationship prior to the marriage. You must complete Part 3 and have this document sworn before a Commissioner for Oaths.
Note: Every person who knowingly makes a false or misleading representation in any application or other proceeding under the Pension Benefits Division Act (PBDA) is guilty of an offence punishable on summary conviction.
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