PWGSC-TPSGC 2265 - Pension information release

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Pension information release

Provision of the personal information (PI) including the social insurance number (SIN) is required pursuant to the Department of Public Works and Government Services Act, section 13 and will be used for the purpose of administrating the Public Service Superannuation Act (PSSA). The PI, including the SIN, will be disclosed between the administrators of the Canada Pension Plan (CPP), Quebec Pension Plan (QPP), and public service pension plan to confirm that the retiree is not receiving a disability pension and to calculate a reduced annuity, if required. Refusal to provide the personal information or the provision of incorrect information could result in the loss of benefits, and/or delays in processing 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 PCE 702 - Federal Pensions Administration. Under the Act individuals have the right to access their personal information and request corrections.

Note

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

Plan member's personal information

Preferred language

Statement of undertaking

I do hereby attest that: A.
B. I am in receipt of benefits under the CPP or the QPP, excluding survivor benefits, as follows:
C.

Important (Please read carefully)

D. If you received your CPP or QPP benefit entitlement notice, please send a copy to the Government of Canada Pension Centre.
E. You will be required to repay any overpayment of your public service pension benefit resulting from any subsequent or retroactive entitlement to disability benefits under the CPP or the QPP.

Authorization

I have read the restrictions and I understand the nature and effect of this authorization to communicate the information in this form to the pension administration named herein.

For office use only

Restrictions

Information will only be communicated if

  • The pension administration certifies in a form satisfactory to the CPP or the QPP, that the information will not be disclosed to any creditor or person not entitled to the information.
  • The person who signs the authorization is the plan member or his legal representative.

This form is to be completed when the monthly public service pension becomes payable.

The completed form must be sent to the address below. You may wish to retain a copy for your records.

Government of Canada Pension Centre
Mail Facility
150 Dion Blvd
PO Box 8000
Matane QC G4W 4T6

PWGSC-TPSGC 2265 (2016-03)