Plan member's personal information
Please provide the following information concerning the recipient of the pension benefit
Check the applicable acts or regulations under which the recipient is entitled to a pension (if known)
Please provide the following information concerning the applicant (the person named in the court order as being entitled to financial support)
If yes, please indicate name and address.
If yes, please indicate full name, and address, and their legal relationship.
Diversion payment made to a person other than the applicant (e.g. family court). Identify the person named in the financial support order
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:
- a certified copy of the certificate evidencing the change where a formal change of name has occurred Or
- 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:
- a child birth certificate Or
- a certified true copy of proof of birth
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.
Note: Mail the completed application to:
Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
Post Office (PO) Box 9500
Matane QC G4W 0H3