ARCHIVED CD 2002-023

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September 11, 2002



1.1 The purpose of this directive is to inform users of the appropriate method of supply for the following forms:

Form Title Form Number
"Declaration of Health" PWGSC-TPSGC 2028-2
"Déclaration d'assurabilité" PWGSC-TPSGC 2028-3

To ensure privacy, these sealable forms will no longer be available electronically (ELF or Compensation Internet Web site).

Note: Form PWGSC-TPSGC 2028-2 is in English only and form PWGSC-TPSGC 2028-3 is in French only.

1.2 In this text, use of the masculine is generic and applies to both men and women.


2.1 The reverse of the PWGSC-TPSGC 2028-2 or the PWGSC-TPSGC 2028-3 forms, MUST be completed by the compensation advisor and then forwarded intact to the applicant, along with an envelope, pre-addressed to Superannuation Directorate. Failure to complete all of the blocks of the tombstone information, including the Individual Agency Number (IAN), can result in delays in the adjudication of applications.

Applicants should be instructed to seal the completed form, place it in the pre-addressed envelope provided and to return it to their compensation advisor for forwarding to the Superannuation Directorate.

Note: Compensation advisors are not permitted to open the completed Declaration of Health form. Only National Life can open completed Declaration of Health forms.

2.2 For additional information on the IAN, please refer to the following:

  • Insurance Form Identifiers

    Tools, Insurance Form Identifiers
  • PPIM 19-7

    Personal Pay Input Manual (PPIM) 19-7, Section: CENTRAL INDEX SYSTEM, Subsection: ON-LINE PROCESSING -- INQUIRY

2.3 National Life has been advised that they can no longer adjudicate applications for coverage on the basis of the old Statement of Health cards. A Broadcast message to advise departments of this was released on April 15, 2001. Please destroy any unused copies of the old form.


3.1 The forms PWGSC-TPSGC 2028-2 and PWGSC-TPSGC 2028-3, can be ordered by completing a "Retail Requisition" form (CCG 0146) and forwarding it to the following address:

EPRINTit Retail Products
1770 Pink Road
Aylmer, Quebec
K1A 1L3

OR by sending it by facsimile to 819-779-2833.

Note: An envelope pre-addressed to the Superannuation Directorate accompanies the above forms.


4.1 Please direct any inquiries regarding the content of this directive to Pension Policy and Advisory Services at 613-952-1008 or by facsimile at 613-952-9809.

Original Signed by
R. Jolicoeur

R. Jolicoeur
Director General
Compensation Sector
Government Operational Service

Reference: CJA: 9243-1, 9243-2-2, 9243-3-1