PWGSC-TPSGC 2196 - Naming or Substitution of a Beneficiary

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Protected "B" when completed

Naming or Substitution of a Beneficiary

For Supplementary Death Benefit (Part II of the Public Service Superannuation Act)

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 Public Service Superannuation Act (PSSA). 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.

This form must be completed electronically. If not possible, please complete it in dark ink and capital letters.

Plan Member's Personal Information

Preferred Language
Preferred Language

Carefully read instructions before completing.

I hereby appoint the following beneficiary and revoke any previous designation.


Participant's Signature
(Must be Signed in Dark Ink)

Witness' Signature - Other than the Beneficiary
(Must be Signed in Dark Ink)

NOTE: You must be a participant in the Supplementary Death Benefit (SDB) plan to complete this form; otherwise, the form will be invalid. You may cancel or change your beneficiary at any time while a participant, whether employed or retired.

Upon your death, your named beneficiary may become entitled to certain lump sum benefits which are payable under Part I of the Public Service Superannuation Act. A naming takes effect the date this form is completed; however, this form must be received by the Government of Canada Pension Centre prior to your death. Therefore, it is recommended that the completed form be forwarded by express mail to the address indicated below.

Important - You may only have one designated beneficiary at a time.

You may designate:

  • any person over 18 years of age on the date of naming;
  • any registered charitable or benevolent organization or institution (name and registration number of the institution are required);
  • any religious or educational organization (name is required);
  • your Estate (print "Estate" in the space provided for the beneficiary). If you only wish to cancel the previous designation and not name a new beneficiary, simply print "Estate".

An ineligible or ambiguous designation will render this form invalid.

For Office Use Only

Instructions

Completion of the Form

  • Complete all unshaded areas. PLEASE PRINT.
  • PRI or Pension No. must be provided.
  • Amendments are not acceptable unless initialed by the participant and the witness.
  • Both the participant and the witness must sign this form in dark ink.

Forwarding of the Form

It is important that this form be received at the address indicated below as soon as possible.

Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Service
150 Dion Blvd
PO Box 8000
Matane QC G4W 4T6

It is recommended that you forward this form by express mail.

  • Government of Canada Pension Centre will acknowledge receipt of your "Naming or Substitution of a Beneficiary" (PWGSC-TPSGC 2196) form.
  • This form will not be returned with the acknowledgement of receipt. Please retain a copy for your records.

PWGSC-TPSGC 2196 (2018-01)