Public Services and Procurement Canada
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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 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.
I hereby appoint the following beneficiary and revoke any previous designation.
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:
An ineligible or ambiguous designation will render this form invalid.
Completion 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.
PWGSC-TPSGC 2196 (2018-01)