Public Services and Procurement Canada
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Protected "B" when completed
Provision of the information requested on this form will be used to process a termination/retirement pension benefit under the Public Service Superannuation Act (PSSA). This personal information will be stored in Personal Information Bank Number PWGSC PCU 702 and will be protected, used and disclosed in accordance with the Privacy Act. Under the Act, you have the right to request access to your personal information and to request corrections should you believe the information contains errors or omissions. Personal information that you provide about another individual may be accessible to that person under the Privacy Act. The information will be retained by the department for two years following the last administration change and then destroyed.
This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.
Is the employee required to work on:
Note: Refer to the instructions as all sections of this form may not have to be completed for a termination.
Is there an existing debt?
Final copy of form PWGSC 2386 to follow.
Completion of this section is only required for a plan member who is 50 years of age or over at termination date or if approved for a medical retirement.
Regional pay offices: Report only payments made up to September 30, 2003 and that are associated with Fund 1 service buybacks (buybacks signed prior to April 1st, 2000).
Non-regional pay offices: Report all service buyback payments made up to and including April, 2011.
Monthly Deductions (final notice) Line 1 From:
Monthly Deductions (final notice) Line 1 To:
Monthly Deductions (final notice) Line 2 From:
Monthly Deductions (final notice) Line 2 To:
Monthly Deductions (final notice) Line 3 From:
Monthly Deductions (final notice) Line 3 To:
Monthly Deductions (final notice) Line 4 From:
Monthly Deductions (final notice) Line 4 To:
Monthly Deductions (final notice) Line 5 From:
Monthly Deductions (final notice) Line 5 To:
Has the debt been recovered either in full or in part?
Debt Recovered
Debt Outstanding
PSSA
PSPF - Regular Contributions
PSPF - Additional Contributions for Correctional Service (CS)
SDB Deficiencies Recovered
This form must be completed within 5 business days of a termination of employment transaction for an employee paying into the pension plan, or within 5 business days of a request from the Pension Centre.
This form is required in some retroactive salary increase situations. For these situations, the 5 business day deadline does not apply.
Check the "Initial Form" box and send to the Pension Centre within 5 business days of a termination of employment transaction.
Once account is finalized (termination payments, recoveries and overpayments are actioned) send another copy of the form to PO with the "Account Finalized" box checked. Note: PO will only complete Part 2 of the form when "Account Finalized" is indicated.
This section is only to be completed for terminations where the SOS date is two years or more after the date of becoming a plan member, or in case of termination from dual employment status.
The Pension Centre must be advised within 14 business days of a termination of employment transaction if there is a possibility that a debt to the Crown will need to be recovered from a pension payment, even if the debt amount is not yet established. The completion and forwarding of the form to the Pension Centre must not be delayed pending confirmation of the debt amount.
Total debt outstanding before recoveries from termination payments must be reported. Recoveries will be reported by PO (see Part 2B).
If a suggested recovery amount is not specified, recovery will be taken at 10% of gross basic pension entitlement.
This section is to be used to report the applicable deductions as listed in Section C. Completion of this section is only required for a plan member who is 50 years of age or over at termination date or if approved for a medical retirement.
This section is only to be completed if Part 1A has been completed. Additional Correctional Service Canada (CSC) contributions must be reported. Attach a separate sheet if space is insufficient.
Debt outstanding is the total debt minus the amounts recovered.
Report a pension adjustment (PA) for the year of termination only.
This section is only to be completed if Part 1A has been completed and the LWOP period ended prior to December 2011.
This section is only to be completed if the LWOP period ended prior to December 2011.
PWGSC-TPSGC 2386 (06/2011)
