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Forms
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Here you will find a collection of forms related to your pension and benefits.
While every reasonable effort has been made to ensure the accessibility of this site, some content or services found here might be inaccessible to some visitors. In those circumstances, please contact us.
All forms on this Web site are available in Portable Document Format (PDF).
This means that if you have Adobe Acrobat Reader software, you will be able to view,
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If you have difficulty downloading forms on this Web site, please contact us.
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Table of Contents |
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Dental Care Plan
Disability Insurance
Preparing for Retirement
Public Service Health Care Plan
Public Service Management Insurance Plan
Public Service Pension Plan
Service Buy Back
Supplementary Death Benefit
Survivor
Forms Available from your Compensation Advisor
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Dental Care Plan |
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Standard Claim Forms
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6267 |
Public Service Dental Care Plan FormTBS
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M6591 |
Public Service Dental Care Plan - Authorization for Claims Submission and Re-Direction of PaymentGreat-West Life
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Disability Insurance |
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Standard Claim Forms
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330-302 |
Claim for Disability Insurance - Employee's Statement Policy No. 12500-GTBS
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330-304 |
Claim for Disability Insurance - Employee's Medical Information and Attending Physician's Statement Policy No. 12500-GTBS |
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Preparing for Retirement |
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Mandatory Forms
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2265 |
Pension Information ReleasePWGSC (PDF 140 KB)
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Optional Forms
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040 |
Request Form - Direct Deposit to the United StatesPWGSC (PDF 483 KB)
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2017 |
Election to Continue as a Participant Under the Supplementary Death Benefit PlanPWGSC (PDF 481 KB)
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2033 |
Request to Deposit Superannuation Cheques in a Financial InstitutionPWGSC (PDF 402 KB)
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Other Forms
If you wish to increase your tax credit beyond the basic personal amount, please complete the TD1 Personal Tax Credits Return Form as well as the corresponding provincial form.
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TD1 Personal Tax Credits Return
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TD1 Personal Tax Credits Return
TD1-WS Worksheet for the Personal Tax Credits Return
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Alberta
TD1AB Alberta Personal Tax Credits Return
TD1AB-WS Worksheet for the Alberta Personal Tax Credits Return
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British Columbia
TD1BC British Columbia Personal Tax Credits Return
TD1BC-WS Worksheet for the British Columbia Personal Tax Credits Return
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Manitoba
TD1MB Manitoba Personal Tax Credits Return
TD1MB-WS Worksheet for the Manitoba Personal Tax Credits Return
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New Brunswick
TD1NB New Brunswick Personal Tax Credits Return
TD1NB-WS Worksheet for the New Brunswick Personal Tax Credits Return |
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Newfoundland and Labrador
TD1NL Newfoundland and Labrador Personal Tax Credits Return
TD1NL-WS Worksheet for the Newfoundland and Labrador Personal Tax Credits Return
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Northwest Territories
TD1NT Northwest Territories Personal Tax Credits Return
TD1NT-WS Worksheet for the Northwest Territories Personal Tax Credits Return
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Nova Scotia
TD1NS Nova Scotia Personal Tax Credits Return
TD1NS-WS Worksheet for the Nova Scotia Personal Tax Credits Return
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Nunavut
TD1NU Nunavut Personal Tax Credits Return
TD1NU-WS Worksheet for the Nunavut Personal Tax Credits Return
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Ontario
TD1ON Ontario Personal Tax Credits Return
TD1ON-WS Worksheet for the Ontario Personal Tax Credits Return
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Prince Edward Island
TD1PE Prince Edward Island Personal Tax Credits Return
TD1PE-WS Worksheet for the Prince Edward Island Personal Tax Credits Return
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Quebec
TP-1015.3-V Source Deductions Return
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Saskatchewan
TD1SK Saskatchewan Personal Tax Credits Return
TD1SK-WS Worksheet for the Saskatchewan Personal Tax Credits Return
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Yukon
TD1YT Yukon Personal Tax Credits Return
TD1YT-WS Worksheet for the Yukon Personal Tax Credits Return
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Public Service Health Care Plan |
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Standard Claim Forms
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6482 |
Public Service Health Care Plan FormTBS |
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Comprehensive Coverage Claim Forms
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6483 |
Out-of-Country Claims Comprehensive CoverageTBS
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Public Service Management Insurance Plan |
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Death Benefit
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5948, 5949 |
Public Service Management Insurance Plan Claim for Death BenefitTBS |
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Long-term Disability Insurance
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5945, 5946 |
Public Service Management Insurance Plan Claim for Long-term Disability BenefitTBS
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5954, 5955 |
Public Service Management Insurance Plan Claim for Accidental Dismemberment BenefitTBS
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Public Service Pension Plan |
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Benefits Division
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2483 |
Statutory Declaration - In the matter of Provision of Pension Benefits Information under the Pension Benefits
Division Act
PWGSC (PDF 18.9 KB)
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2484 |
Statutory Declaration - In the matter of an Application for Division of Pension Benefits under the Pension Benefits
Division ActPWGSC (PDF 95.8 KB)
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2486 |
Application for Division of a Public Service Superannuation Act Pension in Accordance with the Pension
Benefits Division Act
PWGSC (PDF 1.01 MB)
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2488 |
Request for Pension Benefits Division Information with respect to a Public Service Superannuation Act Pension
in Accordance with the Pension Benefits Division ActPWGSC (PDF 19.5 KB)
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Service Buy Back |
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2066 |
Surrender of rights under a Government Annuity Contract
PWGSC (PDF 66.9 KB)
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2081 |
Evidence of Medical Examination
PWGSC (PDF 590 KB)
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2268 |
Release Authorization
PWGSC (PDF 271 KB) |
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Supplementary Death Benefit |
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Reduce Benefit
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2041-1 |
Election to Reduce Benefit to $10,000PWGSC (PDF 275 KB) |
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Naming or Substitution of a Beneficiary
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2196 |
Naming or substitution of a beneficiaryPWGSC (PDF 409 KB) |
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Standard Claim Forms
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2223 |
Supplementary Death Benefit Claim FormPWGSC (PDF 267 KB)
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Survivor |
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Declaration Forms
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2010 |
Statutory Declaration - In the Matter of the Public Service Superannuation Act
PWGSC (PDF 1.46 MB)
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2467 |
Statutory Declaration - Public Service Superannuation Act - Subsection 25(4) - Claimant's Statement
PWGSC (PDF 136 KB)
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2467-1 |
Statutory Declaration - Public Service Superannuation Act - Subsection 25(4) - Supporting Statement
PWGSC (PDF 119 KB)
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Forms Available from your Compensation Advisor |
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Below is a list of additional forms that you may require, however, they are only available from your compensation advisor. |
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Disability Insurance |
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330-303 |
Claim for Disability Insurance - Employer's Statement Policy No. 12500-GTBS |
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Preparing for Retirement |
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Mandatory Forms
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1422 |
Deductions from Annuity or Annual AllowancePWGSC
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2011 |
Notice of Termination and Option for BenefitPWGSC |
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Other Forms
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2011-1 |
Reason for Termination and Option for Benefit Air Traffic Controllers (ATC) Operational ServicePWGSC
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2011-2 |
Option for Benefit - Operational Service, Correctional Service CanadaPWGSC |
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Public Service Management Insurance Plan |
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Basic Life Insurance
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2028 |
Public Service Management Insurance PlanPWGSC
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2028-5 |
Public Service Management Insurance Plan - Part-time employee onlyPWGSC |
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Change of Name or of Beneficiary
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2028-1 |
Public Service Management Insurance Plan (Change of Name or of Beneficiary)PWGSC |
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Long-term Disability Insurance
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2027 |
Long-term Disability Insurance - Public Service Management Insurance PlanPWGSC
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2027-1 |
Long-term Disability Insurance - Public Service Management Insurance Plan (Part-time Employee Only)PWGSC |
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Supplementary Life Insurance
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2028-7 |
Public Service Management Insurance Plan - Members Entitled to Government-Paid CoveragePWGSC
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Service Buy Back |
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2005 |
Election Form for Transfer Value ServicePWGSC
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2006 |
Election Form for Elective Pensionable ServicePWGSC
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2472 |
Estimate Request and Information Release Authorization for Reciprocal Transfer Agreement PurposesPWGSC
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Supplementary Death Benefit |
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2092 |
Election to Surrender BenefitsPWGSC |
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