PWGSC-TPSGC 2488 - Request for Pension Benefits Division Information (for estimate purposes) with respect to a Public Service Superannuation Act pension in accordance with the Pension Benefits Division Act

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PROTECTED B (when completed)

Request for Pension Benefits Division Information (for estimate purposes) with respect to a Public Service Superannuation Act pension in accordance with the Pension Benefits Division Act

Privacy statement

Provision of the information requested on this document is voluntary. Provision of personal information is required pursuant to the Department of Public Works and Government Services Act, sections 7(1)(d) and 13 and will be used by the Pension Centre for the purpose of administrating the Public Service Superannuation Act (PSSA). This information is being collected for the purpose of documenting a 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 described in Personal Information Bank PWGSC PCE 702—Federal Pension Administration. Under the Act, individuals have the right to request access to their personal information and to request corrections, if erroneous or incomplete. To submit a request, individuals may contact the department’s Access to Information and Privacy Protection Directorate, Privacy Management Division at: At any time, individuals have the right to file a complaint with the Office of the Privacy Commissioner of Canada regarding PSPC’s handling of their personal information. By providing your personal information, you acknowledge that you have read and understood this statement and consent to the Department’s collection, use and disclosure of your personal information.

Note: You can fill out this form electronically and print it. Or you can print a blank form and fill it out in dark ink using capital letters.

A. Applicant’s information

I'm applying as the

B. Send the requested pension benefits division information to this address

The above is my current mailing address:

C. Plan Member's information

D. Other information

The person who would be receiving the division amount from the plan member’s pension benefits is (or was) employed with the:

E. Confirm beneficiary status for Supplementary Death Benefit (only if stipulated in an attached court order or written agreement)

I hereby request confirmation as to whether the person named in the attached document is the named beneficiary of the plan member's Supplementary Death Benefit under the Public Service Superannuation Act (PSSA). In support of this request, I have attached a certified true copy of a court order or written agreement stating that I am to be named the beneficiary, or that I am entitled to this confirmation.

F. Enclose these supporting documents with your request (as applicable)

Supporting Documents

G. Applicant's Signature

I hereby request pension benefits division information in respect of the plan member named in Section C of this request, in accordance with the Pension Benefits Division Act (PBDA).

If I am not the plan member, I understand that a note regarding this request will be added to the plan member's personal records once the information is sent to me.

I would like to receive the requested information in:

H. How to submit your request for pension benefit division information

Ensure you write the plan member’s service number (PRI) or pension number in the top right-hand corner of each page submitted.

Mail or fax this completed Request for Pension Benefit Division Information (for estimate purposes) [PWGSC-TPSGC 2488E] form and any supporting documents to:

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

Fax: 1-418-566-6298

Important: The original or certified true copy of a personal representative document must be mailed, not faxed.

Note: Every person who knowingly makes a false or misleading representation in any application or other proceeding under the PBDA is guilty of an offence punishable on summary conviction.

PWGSC-TPSGC 2488E (2023-09-20)