PWGSC-TPSGC 577 - Plan Member Contact Information

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Protected "B" when completed

Plan Member Contact Information

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 using capital letters.

Plan Member's Personal Information

Preferred Language
Preferred Language

Additional Plan Member Personal Information

To be completed by the Compensation Advisor

For Office Use Only


This form is to be completed by the employing organization when an employee becomes eligible to contribute to the Public Service pension plan. This information will allow the pension administrator to communicate with the plan member directly. A delay in forwarding this information to the pension administrator could result in communications to the plan member being sent to the employing organization.

Please note that the Pension Number is not required.

This form is to be forwarded to the pension administrator by fax (1-418-566-6298). If a fax machine is not available, the form can be mailed to:

Government of Canada Pension Centre - Mail Facility
150 Dion Blvd.
P.O. Box 8000
Matane QC G4W 4T6

PWGSC-TPSGC 577 (05-2014)