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FIELD: ORIGINAL, AMENDMENT TO
ORIGINAL, DATED |
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Insert a check mark in the appropriate box to
indicate if the form is an original or an amendment to an original.
Note: The date of the original must be entered in the case of
an amendment.
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FIELD: SURNAME |
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Insert the employee's family name to a maximum
of 25 alphanumeric characters. |
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FIELD: INITIALS |
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Insert the employee's initials to a maximum
of 3-alpha characters. |
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FIELD: DEPT. |
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Insert the 3-alpha character official name of the applicable department,
Crown corporation or agency. |
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FIELD: PO |
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Insert the 2-digit numeric code of the PWGSC
pay office, Crown corporation or agency. |
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FIELD: PAYLIST |
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Insert the 4-digit numeric code to identify
the employee's paylist. If less than 4 digits, use leading zero(s). |
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Example:
| Department |
AGR |
| Pay Office number |
66 |
| Paylist number |
123 |
| The entry would be |
AGR660123 |
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FIELD: SUPERANNUATION No. |
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Insert the employee's superannuation number
as assigned by the Superannuation, Pension Transition and Client Services Sector. |
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FIELD: PRI |
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Insert the employee's Personal Record Identifier
(PRI). |
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FIELD: THIS FORM IS INITIATED FOR |
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Insert a check mark in the appropriate box.
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Note: This field is used to identify
the purpose of the form and to indicate the employee's benefit option. |
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PERSONNEL OFFICER CERTIFICATION |
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FIELD: DOES THE EMPLOYEE WORK ON WEEKENDS?
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Insert a check mark to indicate whether or not
the employee is required to work on weekends. |
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Note: This field must be completed in
all cases where the employee's struck off strength (SOS) date is on a Sunday
or a Monday. |
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FIELD: DATE OF SOS |
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Insert the date on which the employee will be
SOS, in year-month-day format, e.g. 1998-10-30 for October
30, 1998. |
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Note: Do not fill in this field if the
reason for initiation is the "division of pension benefits". |
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FIELDS: FINAL SALARY, SUPERANNUABLE ALLOWANCE, FINAL CLASSIFICATION AND LEVEL, AUTHORITY FOR FINAL SALARY, DATE OF AUTHORITY |
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- Insert the last rate of salary authorized (hourly, monthly, daily, etc.), in an annualized value.
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- Insert the last rate of allowance in an annualized value.
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- Insert the classification and level of the employee at date of SOS.
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- Insert the authority for paying the employee's final salary e.g. collective bargaining agreement, arbitral awards, Treasury Board minutes, promotion certificates, etc.
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- Insert the effective date of the signing authority in the year-month-day format, e.g. 1999-03-31 for March 31, 1999.
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FIELDS: NAME, TELEPHONE No., FACSIMILE No.,
LOCATION, SIGNATURE, DATE |
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Insert the following:
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- Your name (in block letters);
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- Your telephone and facsimile numbers, including the area code;
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- The date on which the form was completed.
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CERTIFICATION BY PAY OFFICE
- CONTRIBUTIONS |
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PENSION ADJUSTMENT
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Insert the amount in dollars and cents of the
Pension Adjustment (PA) as well as the year to which applies. |
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Note: Complete this section for transfer
value, pension transfer agreement, reciprocal transfer agreement and cash termination allowance. |
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ELECTIONS |
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Note: The Superannuation, Pension Transition, and Client Services Sector
requires an accurate report of all arrears deductions
associated with the purchase of prior elective service. |
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INSTALLMENTS (FINAL NOTICE) |
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Note: Care must be taken to ensure that
all cash payments and monthly installments on arrears are entered exactly
as deducted. Since the form provides for only 14 periods of installments,
any additional periods and amounts must be entered on a second or third
page as applicable. |
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FIELD: FROM_ TO _ |
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Insert the "From and To" month and
year for each monthly installment amount as deducted from pay in month-year
format, e.g. 08-92 to 09-97. |
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FIELD: No. OF MONTHS |
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Insert the number of months that the "From
and To" period represents. |
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FIELD: MONTHLY AMOUNT |
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Insert the monthly installments in dollars and
cents for each "From and To" period. |
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Note 1: If the employee transfers between
a PWGSC pay office and a non-PWGSC pay office or vice versa, the PWGSC-TPSGC
2386 must be certified at the time of transfer and all arrears installments
deducted must be certified. Forward the PWGSC-TPSGC
2386 directly to the
Superannuation, Pension Transition and Client Services Sector. The new pay office will use the month and year
in which the installments commenced in the new pay office as the installments
"From" date.
Note 2: If the employee transfers from one PWGSC pay office to another
PWGSC pay office, the last pay office is responsible for reporting and certifying
all arrears installments/payments as they were deducted from pay. |
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OUTSTANDING DEFICIENCIES
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FIELD: PAST SERVICE ARREARS...
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Insert a check mark in the appropriate box;
insert the amount (in dollars and cents) and date of recovery (in year-month-day
format), if required. |
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Note: This field is completed whenever
past service arrears are recovered from a termination payment. The Superannuation, Pension Transition and Client Services Sector requires the information to verify that outstanding past service
arrears have been recovered from a termination payment. |
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FIELD : PERIOD OF LWOP |
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Insert the "From and To" dates of
the period of LWOP, in year-month-day format, e.g. 1988-03-02 to 1998-03-26
for a period from March 2, 1998 to March 26, 1998. INSERT a check mark in
the appropriate box to indicate whether or not deficiencies have been collected.
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FIELD: SUPPLEMENTARY DEATH BENEFIT |
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Insert the amount of the deficiency in dollars
and cents; insert a check mark in the appropriate box to indicate whether
or not deficiencies have been collected. |
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PSSA/PSPF/RCA |
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FIELD: CURRENT DEFICIENCIES |
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Insert the amount of outstanding pension deficiencies
in dollars and cents. |
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35 YEARS SERVICE |
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FIELD: CONTRIBUTIONS CEASED ON: |
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Insert the date on which PSSA contributions
were stopped, in year-month-day format, e.g. 1998-06-01 for June 1, 1998.
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CERTIFICATION |
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FIELDS: NAME, TELEPHONE No., FACSIMILE No.,
LOCATION, SIGNATURE, DATE |
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Insert the following:
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- Your name (in block letters);
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- Your telephone and facsimile numbers, including the area code;
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- The date on which the form was completed.
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