Public Services and Procurement Canada
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This information is being collected in accordance with the Public Service Superannuation Act (PSSA) for the purpose of confirming that the employee meets the requirements for a waiver of the reduction to his pension, when a reduction exists. This personal information will be stored in Personal Information Bank Number PWGSC PCE 702 and will be protected, used and disclosed in accordance with the Privacy Act. Under this act, employees have the right to request access to their personal information and to request corrections should they believe the information contains errors or omissions. Personal information provided about another individual may be accessible to that person under the Privacy Act. The records will be retained by the department for two years following the last administrative action, and then will be destroyed.
This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.
The above-named individual was at least age 55 at termination and has been employed in the public service for at least 10 years and is ceasing to be employed as a result of a workforce adjustment situation. I certify that the individual concerned has met the criteria established by Treasury Board for a waiver of the reduction to his pension, as indicated below:
An employee for whom Treasury Board is not the employer and who:
is an employee whose services are no longer required by reason of the transfer of work or function to an employer outside the public service and who is not offered contiguous employment with the new employer;
PWGSC-TPSGC 2429-1 (12/2009)