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Service Buyback Package

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					Service Buyback Package




                      Version 1.3
                                                   TABLE OF CONTENT

1.0. GENERAL INFORMATION .................................................................................... 3 
2.0. MAKING THE DECISION TO BUY BACK SERVICE ....................................... 3 
   2.1. ADVANTAGES ........................................................................................................... 3 
   2.2. PRIOR SERVICE ......................................................................................................... 4 
      2.2.1. Surrendering Previous Pension Entitlements ................................................... 4 
      2.2.2. Buying Back Partial Periods of Prior Service .................................................. 4 
      2.2.3. Description of the Different Types of Prior Service ......................................... 5 
          2.2.3.1. Prior Federal Public Service ...................................................................... 5 
          2.2.3.2. Service with the Canadian Forces or the Royal Canadian Mounted Police
          ................................................................................................................................. 5 
          2.2.3.3. Service as a Member of Parliament ........................................................... 6 
          2.2.3.4. Pensionable Employment Outside of the Federal Public Service .............. 7 
          2.2.3.5. Pension Transfer Agreements .................................................................... 8 
          2.2.3.6. Other Types of Prior Service ..................................................................... 8 
   2.3. COSTING ................................................................................................................... 9 
   2.4. TAX IMPLICATIONS ................................................................................................. 10 
      2.4.1. Past Service Pension Adjustment (PSPA) Certification ................................. 10 
      2.4.2. Deductibility of Registered Pension Plan Contributions ................................ 10 
      2.4.3. Deductibility of Retirement Compensation Arrangement (RCA) Contributions
      ................................................................................................................................... 11 
3.0. THE ADMINISTRATIVE PROCESS ................................................................... 11 
   3.1. ESTIMATES .............................................................................................................. 11 
      3.1.1. Limitations ...................................................................................................... 12 
   3.2. MEDICAL EXAMINATIONS ....................................................................................... 12 
   3.3. ELECTION FORM...................................................................................................... 14 
   3.4. PAYMENTS .............................................................................................................. 15 
      3.4.1. Lump Sum Payments versus Monthly Instalments .......................................... 15 
      3.4.2. Cash Lump Sum Payments ............................................................................. 15 
      3.4.3. Direct Transfer from a Registered Retirement Savings Plan (RRSP) ........... 16 
      3.4.4. Direct Transfer From Your Former Pension Plan ........................................ 16 
      3.4.5. Monthly Instalments ....................................................................................... 17 
   3.5. COMPLAINT ESCALATION PROCESS ........................................................................ 18 
APPENDIX A - CONTACT US..................................................................................... 19 
APPENDIX B – FORMS ................................................................................................ 21 




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1.0. General information

This package provides you with information about elections to purchase prior
pensionable service also known as buying back service.

Note: If there is a discrepancy between any printed version and the electronic version of
this document, the electronic version, located at http://www.tpsgc-
pwgsc.gc.ca/pension/act/rachat-buyback/index-eng.html, will prevail. Version 1.3 of this
document was updated on April 22, 2010.

The Public Service Pension Centre is the primary office responsible for the
administration of the pension plan for Federal Public Service employees. If you require
more information on this package, consult with the Pension Centre (see Appendix A –
Contact us).

A service buyback is a legally binding agreement to purchase a period of prior service to
increase your pensionable service under the Federal Public Service pension plan. It may
include a period of prior Federal Public Service or pensionable employment, with
another employer. Refer to Section 2.2. on Prior Service for further details.

Normally, you may buy back service at any time while you are employed in the Federal
Public Service and contributing under the Public Service pension plan. Cost and other
requirements may vary, depending on the type of service and when you make the
buyback. The type and period of service has to be verified before the service buyback is
approved.

You may only accumulate up to a maximum of 35 years of pensionable service. This 35
year maximum includes the following:

   •   Service for which you contributed to the Public Service pension plan. This
       includes both current contributory service and service which you have purchased
       (service buyback) or transferred from another pension plan;
   •   Service under the Canadian Forces pension plan;
   •   Service under the Royal Canadian Mounted Police pension plan.

When any of the elective service you are buying back occurred on or after January
1, 1990, a Past Service Pension Adjustment (PSPA) calculation must be
performed. A PSPA greater than $50.00 must be certified by the Canada Revenue
Agency (CRA) before that service can be counted as pensionable under the Public
Service pension plan. Refer to section 2.4. on Tax Implications for further details.


2.0. Making the Decision to Buy Back Service

       2.1. Advantages

           Advantages of buying back prior service include:

               Increased pensionable service, which increases your pension,



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               Increased pension benefit for your survivors,

               The completion of 35 years of pensionable service at an earlier date,

               The possibility of retiring earlier.


       All pension benefits payable under the plan relate directly to service and salaries.
       As the number of years of pensionable service to your credit increases and you
       reach higher levels of salary, the pension benefits that you and your eligible
       survivors can expect to receive increase accordingly.

       2.2. Prior Service

       You may buy back the following types of prior service:

          •   Prior Federal Public Service
          •   Service with the Canadian Forces or the Royal Canadian Mounted Police
          •   Service as a Member of Parliament
          •   Pensionable Employment Outside of the Federal Public Service
          •   Other Types of Prior Service

       Here are some elements to consider when buying back prior pensionable
       service:

              2.2.1. Surrendering Previous Pension Entitlements

              Please keep in mind that you must surrender any pension entitlement you
              may have with another employer before you can count that service as
              pensionable under the Public Service pension plan. Once you complete
              an Election Form for Elective Pensionable Service (PWGSC-TPSGC
              3006 in Appendix B), the Pension Centre will contact you with details
              concerning the surrender of your previous entitlement. Refer to section
              2.4. for additional information on Tax Implications.

              You should also remember that, if you leave the Federal Public Service
              voluntarily with less than two years of continuous employment, you are
              only entitled to a return of your contributions paid into the Public Service
              pension plan.

              Consequently, if you intend to leave within that period, you should
              consider whether it is in your interest to surrender the entitlement under
              the outside plan. This provision does not apply if your termination from
              the Federal Public Service is involuntary. Consult with the Pension
              Centre if you require more information (see Appendix A – Contact us).

              2.2.2. Buying Back Partial Periods of Prior Service

              You may buy back all or part of a period of prior service. If you are buying
              a part of a period, in most cases, it must be for the part that occurred


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              most recently. The Pension Centre can provide you with information
              about exceptions to this requirement.


              2.2.3. Description of the Different Types of Prior Service

                     2.2.3.1. Prior Federal Public Service

                     You may buy back virtually any type of prior Federal Public
                     Service. This includes periods of part time service after 1980 for
                     which the assigned work week averaged at least 12 hours. It also
                     includes periods of leave without pay which you previously chose
                     not to count.

                     The cost of buying back periods of leave without pay that you
                     chose not to count on return to work will be based on your salary
                     at the time you make your election to buy back service. This
                     service will be costed at a single or double rate of contributions
                     depending on the type of leave. Interest will be added in the same
                     manner as it is for other prior service; that is, four per cent simple
                     interest from the date of the service to the month in which you
                     submit the Election Form for Elective Pensionable Service
                     (PWGSC-TPSGC 3006 in Appendix B).

                     If you received a transfer value in respect of a previous period of
                     employment, you may, in some circumstances, buy it back. It is
                     important to note that there is a limited period of time within
                     which you must make your option to buy back this service.
                     The cost and method of payment is different for reinstatement of
                     transfer value service. Please contact the Pension Centre for an
                     estimate of cost for this type of service (see Appendix A – Contact
                     us).

                     2.2.3.2. Service with the Canadian Forces or the Royal
                     Canadian Mounted Police

                     You may buy back different types of service depending on your
                     pension benefit entitlement status under one of the following
                     pension plans: the Canadian Forces pension plan, or the Royal
                     Canadian Mounted Police pension plan.

                     The cost to count the service depends on when you are making
                     your election and the category that describes your service:

                     •     Prior non-contributory service

                     •     Contributory service for which you received or are entitled to
                           receive a return of contributions




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                     •     Contributory service for which you are in receipt or are entitled
                           to a pension benefit.

                     If you are in receipt of a pension under one of these plans, you
                     may surrender your pension entitlement in order to combine all
                     your pensionable service under the Public Service pension plan.
                     In that case, all pension benefits received from your former plan,
                     after your first year as a plan member under the Public Service
                     pension plan, must be repaid to them. You must also continue to
                     pay any amount you still owe under the former plan.

                     Once a plan member chooses to buy back service under this
                     section, he surrenders his right to any pension benefit
                     entitlement under the Canadian Forces or the RCMP pension
                     plan in respect of that service. Prior to signing the Election
                     to Surrender Benefits form, you may wish to obtain an
                     estimate of the increase to your pension as a result of
                     counting the service under the Public Service pension plan.
                     Only the Specialized Services Division of either the Canadian
                     Forces or RCMP can advise you of the monthly cost to repay
                     your pension and any other amount you owe to those plan
                     administrations. You may contact them at the address found
                     in Part B of the Election to Surrender Benefits form.

                     Election to Surrender Benefits Form (PWGSC-TPSGC 2092 in
                     Appendix B)

                     2.2.3.3. Service as a Member of Parliament

                     You may buy back your prior service by surrendering your pension
                     entitlement under the Members of Parliament pension plan. The
                     cost of counting this prior service depends on whether you
                     became entitled to a pension or a withdrawal (lump-sum payment)
                     on ceasing to be a member under that plan.

                     If you are entitled to a pension, you must surrender it and repay,
                     with interest at four per cent per annum, any pension you received
                     after your first year as a Public Service pension plan member. You
                     must also pay any contributions still owing under the Members of
                     Parliament pension plan and pass a Medical Examination.

                     If you received a lump-sum payment under the Members of
                     Parliament pension plan, you will contribute based on your salary
                     when you most recently became a Public Service pension plan
                     member. In this case, you must buy back your service within one
                     year of becoming a Public Service pension plan member. Interest
                     is added from the time the service occurred until the date you
                     make your election to count the service under the Public Service
                     pension plan.




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                     As the benefit formula under the Members of Parliament pension
                     plan is significantly different from that of the Public Service
                     pension plan, you should obtain an estimate of your pension
                     benefits payable as well as the cost to count this service under the
                     Public Service pension plan before surrendering your benefit
                     entitlement. For an estimate, please contact the Pension and
                     Benefits Sector of the Treasury Board Secretariat.

                     2.2.3.4. Pensionable Employment Outside of the Federal
                     Public Service

                     Pensionable employment is any employment outside the Federal
                     Public Service with an established pension plan which has been
                     approved for Public Service pension plan purposes. You must
                     have been a member of the former pension plan.
                     The Public Service pension plan only permits the counting of a
                     period of pensionable employment if it accrued under a pension
                     plan which was registered under the Income Tax Act (ITA). Your
                     pensionable employment must have occurred immediately before
                     you joined the Federal Public Service. When the interval between
                     terminating pensionable employment and joining the Federal
                     Public Service is more than 6 months but less than two years, the
                     Pension Centre will determine whether the service is “immediately
                     prior". If the interval between terminating pensionable employment
                     and joining the Federal Public Service is more than 2 years, the
                     service cannot be purchased.

                     You must also surrender any pension benefit entitlement
                     under your former plan in order to count this service under
                     the Public Service pension plan. The outside employer will
                     have to agree to the surrender.

                     You should also remember that, if you leave the Federal Public
                     Service voluntarily with less than two years of continuous
                     employment, you are only entitled to a return of your contributions
                     paid into the Public Service pension plan.

                     Consequently, if you intend to leave within that period, you should
                     consider whether it is in your interest to surrender the entitlement
                     under the outside plan. This provision does not apply if your
                     termination from the Federal Public Service is involuntary.

                     Before making a decision concerning the value of surrendering a
                     pension entitlement with your former employer, please carefully
                     evaluate the potential benefits payable under your former plan
                     against the additional benefit payable under the Public Service
                     pension plan. To obtain benefit estimates under the Public Service
                     pension plan, you can access the web Pension Calculator
                     (http://apppen-penapp.tpsgc-pwgsc.gc.ca/penavg-
                     penben_prod/cpr-pbc/entree-input.do?lang=en) or contact the
                     Pension Centre for an estimate of cost (see Appendix A – Contact

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                     us). In addition, we strongly recommend that you consult with a
                     financial advisor at your own expense to assist you in evaluating
                     your options under both plans.

                     Before surrendering an annuity entitlement with an outside
                     employer, it is very important that you understand the various
                     payment options and financial implications specific to this
                     type of buyback. Please contact the Pension Centre prior to
                     completing your election form (see Appendix A – Contact us).

                     If you decide to surrender and buyback your outside employment,
                     you must complete the form Pensionable Employment
                     Questionnaire (PWGSC-TPSGC 2069 in Appendix B) and forward
                     to your former employer.

                     When the Pension Centre receives your completed Election Form
                     For Elective Pensionable Service (PWGSC-TPSGC 3006 in
                     Appendix B), they will contact you with details concerning the
                     surrender.

                     For information on the cost of prior service, refer to section 2.3.

                     2.2.3.5. Pension Transfer Agreements

                     Pension Transfer Agreements (PTA) provide another way of
                     counting your prior pensionable service with an outside employer
                     under the Public Service pension plan.

                     If you leave outside employment to become employed in the
                     Federal Public Service and a PTA has been negotiated between
                     the two employers, you may be eligible to transfer all or part of
                     your accrued pension credits to the Public Service pension plan.
                     Please note that the acquired pension credits under the Public
                     Service pension plan as a result of the transfer may not be
                     equivalent to the exporting employer's pension credits. For
                     example, this may occur when the benefit formula under your
                     previous employer's pension plan was lower than the one under
                     the Public Service pension plan.

                     For more information about a PTA, please contact the Pension
                     Centre (see Appendix A – Contact us). You may also refer to the
                     Pension Portability Package at the following address:
                     http://www.tpsgc-pwgsc.gc.ca/pension/act/transfr/accords-
                     aggrmnts-eng.html.


                     2.2.3.6. Other Types of Prior Service

                     You may be able to buy back other types of prior service. You
                     should consult the Pension Centre (see Appendix A – Contact us)


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                      if you have any questions about whether you can buy back a
                      specific period of prior service.


       2.3. Costing

       Salary, rates of contribution and age all affect the cost of buying back service.
       Depending on when you buy back service, different salary rates are used to
       calculate the cost.

       If you complete, sign and forward an Election Form for Elective Pensionable
       Service (PWGSC-TPSGC 3006 in Appendix B) within one year of the issuance of
       your Notification of Plan Membership (PWGSC-TPSGC 2018), your election is
       considered to be a "normal” election. In this situation, the salary used to calculate
       the cost of buying back service is your salary on the date you most recently
       became a plan member.

       If you complete and sign an Election Form for Elective Pensionable Service
       (PWGSC-TPSGC 3006 in Appendix B) after that one year period, it is considered
       to be a "late" election. The salary rate used is the salary authorized to be paid on
       the date you signed the election form. In many cases, this could cost you
       substantially more. For a "late" election, the form must be forwarded to the
       address indicated within one month of the date of signing.

       Please note that you can use the same form to buyback more than one period of
       service. The costing may be different for each one depending on the factors
       indicated above and whether you previously had an opportunity to elect for the
       service in question under the Public Service pension plan.

       Before buying back service you should obtain an estimate of what your prior
       service will cost. You can use the Service Buyback Estimator (http://apppen-
       penapp.tpsgc-pwgsc.gc.ca/penavg-penben_prod/ers-sbe/entree-
       input.do?lang=en) or request an estimate from the Pension Centre (see
       Appendix A – Contact us). However, if your “normal” election expiry date is
       approaching you may want to consider buying back without an estimate.

       The method used to determine the cost of a period of service is a contribution
       based calculation. Contributions plus interest are calculated for the period of
       service based on the applicable salary rate.

       Your contribution rate may be single or double. You may be required to pay both
       employee and employer contributions. For example, pensionable employment
       outside the Federal Public Service is one type of service calculated at a double
       rate of contributions.

       The cash cost of service is the lump sum amount payable at the time you are
       making the election. The cash cost of elective service includes 4% simple
       interest, calculated from the middle of each fiscal year when the service occurred
       to the first day of the month in which you sign the election form.




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       If you choose to pay your past service through monthly instalments, the monthly
       amount is based on the cash cost plus additional interest and mortality charges.


       2.4. Tax Implications

              2.4.1. Past Service Pension Adjustment (PSPA) Certification

              Under the Income Tax Act rules for Registered Pension Plans (RPP), a
              plan may not recognize periods of past service that occurred after
              December 31, 1989 for pension purposes unless officials of the Canada
              Revenue Agency (CRA) certify the PSPA calculated and reported in
              respect of that service. If your RRSP deduction limit (RRSP room) does
              not permit the certification of the PSPA, your prior service cannot be
              counted and any payments you may have made will be refunded to you.

              Generally, this certification depends on whether the PSPA exceeds your
              unused RRSP room at the end of the previous year by more than $8,000.
              Your unused RRSP deduction limit for the previous year is indicated on
              your most recent “Notice of Assessment” issued by CRA.

              If you have made maximum RRSP contributions over the years, your
              RRSP deduction limit may be insufficient to allow certification of the
              PSPA associated with your past service. In this situation, CRA will
              contact you and may allow up to a negative $8,000 RRSP deduction limit
              to certify a PSPA. In this case, you would be unable to make additional
              RRSP contributions until your RRSP deduction limit reaches a positive
              value. As an alternative, you may transfer RRSP funds directly to the
              Pension Centre. Another option is that CRA may allow you to designate
              a qualifying RRSP withdrawal to allow the PSPA to be certified.

              Normally, a direct transfer of funds from your RRSP received prior to the
              PSPA calculation reduces the amount of the PSPA reported to CRA. If
              you feel you may not have sufficient RRSP room to allow certification of
              the PSPA, you may wish to consider paying part of your past service by
              completing a Direct Transfer under subsection 146.3(14.1) or paragraph
              146(16)(a) or 146.3(2)(e) form for RRSP transfers located at:
              http://www.cra-arc.gc.ca/E/pbg/tf/t2033 (T2033 in Appendix B).

              2.4.2. Deductibility of Registered Pension Plan Contributions

              Payments made through a direct transfer from registered vehicles, i.e.
              regular RRSP, locked-in RRSP, registered pension plans, deferred profit
              sharing plans (DPSP) and Locked-in Retirement Account (LIRA) are
              transferred on a tax sheltered basis. The Income Tax Act provides that
              the amount of such a transfer is not included in calculating an individual’s
              income, nor can that individual claim any deduction for the amount of the
              transfer.




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              The tax deductibility of cash contributions (monthly instalments or lump
              sum payment by cheque) paid to buy back service is as follows:

              •   For contributions for service, which occurred prior to January 1, 1990,
                  and for which you contributed to an RPP, the tax deductibility is
                  limited to $3,500 per year minus current contributions and other past
                  service contributions.
              •   For contributions for service, which occurred prior to January 1, 1990,
                  and for which you did not contribute to an RPP, the tax deductibility is
                  limited to $3,500 per year, in addition to contributions made for your
                  current service. The total overall tax limit for these contributions is
                  determined as follows: $3,500 x the number of years or partial years
                  of this type of service purchased.
              •   Contributions for service which occurred after December 31, 1989 are
                  fully tax deductible for the tax year in which they were paid. There is
                  no limit to the tax deductibility of post-1989 contributions provided you
                  have equal net taxable income for that year. You may consult
                  Chapter 1 of CRA’s guide entitled RRSPs and Other Registered Plans
                  for Retirement T4040 at http://www.cra-
                  arc.gc.ca/E/pub/tg/t4040/t4040-e.html for further information on the
                  tax deductibility of Registered Pension Plan contributions.


              2.4.3. Deductibility of Retirement Compensation Arrangement (RCA)
              Contributions

              The Income Tax Act requires that any RCA portion of the cost of past
              service must be paid by a cash payment (s). Normally, RCA contributions
              are fully taxing deductible in the year you make them.

              You cannot pay for RCA contributions via a direct transfer of registered
              funds such as a regular RRSP, a locked-in RRSP, another Registered
              Pension Plan, a DPSP or a LIRA, for example.

              For additional information regarding your tax situation please contact your
              local CRA office at http://www.cra-arc.gc.ca/cntct/tso-bsf-eng.html.


3.0. The Administrative Process

When you decide to buy back service, familiarize yourself with the following so that you
are comfortable with the process:

       3.1. Estimates

       You may estimate the cost of buying back service by using the Service Buyback
       Estimator (http://apppen-penapp.tpsgc-pwgsc.gc.ca/penavg-penben_prod/ers-
       sbe/entree-input.do?lang=en) however, there are various limitations on estimates
       generated by this method. If you are unable to estimate the cost of your service



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       because of these limitations, please contact the Pension Centre to obtain an
       estimate.

       Before performing an estimate or contacting the Pension Centre, you should
       have the following information on hand:

          •   Date of Joining the Plan
          •   Annual Salary
          •   Service Type
          •   Service Buyback Periods

       Once you have reviewed the information in this document and decided to buy
       back service, you may consult the Pension Centre for any additional information
       (see Appendix A – Contact us).

              3.1.1. Limitations

              There are certain types of Service Buyback that cannot be estimated
              by the Service Buyback Estimator. For these types of service please
              contact the Pension Centre to obtain an estimate. The following are the
              limitations of the Service Buyback Estimator:

              •   If your service includes part-time periods, the Service Buyback cost
                  estimate will be overstated since the estimator is designed for
                  estimating full-time service only.
              •   The estimator will not provide a Service Buyback cost estimate
                  based on operational service under Correctional Service Canada
                  (CSC), nor, on service as an Air Traffic Controller (ATC).
              •   The estimator does not calculate the cost of electing to count
                  periods of leave without pay.
              •   The estimator does not calculate the costs of transfers of service.
              •   The estimator does not calculate the cost of Reinstatement of
                  Transfer Value Service.

       3.2. Medical Examinations

       With few exceptions, if you buy back prior service, you will have to undergo a
       medical examination.

       If you buy back service within one year from the date of issuance of your written
       Notification of Plan Membership (PWGSC-TPSGC 2018) under the pension plan
       (also known as a “normal” election) and you fall into one of the following
       categories, you will not need to undergo a medical examination:

          •   You are buying back prior Federal Public Service that ended immediately
              prior to the date you became a plan member. This means that there
              cannot be a break in service;




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              Or

          •   You have been continuously employed in the Federal Public Service for
              at least five years. This may include a combination of employment as a
              member of the Canadian Forces or the Royal Canadian Mounted Police.
              This means that you have had no breaks in employment in excess of
              three months.

       For all other “normal” elections, a medical must be undergone to validate your
       election. Should you undergo but fail the examination, neither you nor your
       survivors would be entitled to pension benefits in respect of the service buyback
       unless you remain employed in the Federal Public Service for five years from the
       date of the failed examination. If you do not remain employed in the Federal
       Public Service for five years, then the payments for the elective service will be
       refunded. Interest is only payable on the contributions that have been in the fund
       for at least two years. However, if you undergo and pass a subsequent medical
       examination within this five-year period and are still employed, then the buyback
       will be validated.

       The following are circumstances under which you must pass a medical
       examination:

          •   You are buying back service after one year from the date of issuance of
              written Notification of Plan Membership (PWGSC-TPSGC 2018), also
              known as a “late” election;
          •   You are buying back service as a former member of the Canadian Forces
              or the Royal Canadian Mounted Police, or as a former Member of
              Parliament and you choose to surrender your pension entitlement under
              these plans;
          •   You are buying back a period of Leave Without Pay (LWOP) which you
              had previously chosen not to count;
          •   You are buying back the balance of service, which was not purchased
              under a pension transfer. Refer to Medical requirements associated with
              a PTA.

       If you do not pass the medical examination, the service cannot be counted.

       You must undergo the examination not more than 90 days before or six months
       after the date of signing the election form. You should therefore contact your
       physician as soon as possible and advise the Pension Centre if you experience
       difficulty in obtaining an appointment within this timeframe. The medical
       examination is undergone at your own expense.

       The following forms, which your physician must fill out, sign and forward, are
       required for your medical examination and will be provided by the Pension
       Centre.

          •   Evidence of Medical Examination (PWGSC-TPSGC 2081)




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       Keep a copy for your records and send the original to the Pension Centre.

          •   Occupational Health Assessment Report (HC-SC 3312)

       Complete, sign and date section D. Your physician must complete sections B, E
       and F and the form should then be mailed to Health Canada at the address
       provided to you by the Pension Centre.

       3.3. Election Form

       All of the forms mentioned in this section are in PDF format, which means that
       you need the Adobe Acrobat Reader to be able to view and print them. To obtain
       copies of these forms in a format designed to meet the needs of the visually
       impaired, please contact the Pension Centre (see Appendix A – Contact us).

       In order to buy back service you must complete the following form, keep a copy
       for your records and send the original by registered mail to the address
       indicated on the form.

       Election Form for Elective Pensionable Service (PWGSC-TPSGC 3006 in
       Appendix B)

       To complete the Election Form for Elective Pensionable Service, you must enter
       your name, Personal Record Identifier (PRI), date of birth, gender, home
       address, phone number, email address, the period(s) you wish to buy back, the
       method and required amount of payments. You must also sign and date the
       form.

       If you are making a “normal” election, you must complete, sign and forward the
       form to the address indicated on the form within one year of the date the
       Notification of Plan Membership (PWGSC-TPSGC 2018) was issued.

       If you are making a “late” election you must forward the completed form to the
       address indicated within one month of the date you signed the election form in
       order for it to be valid.

       Please refer to section 2.3. of this document for information on how the cost of a
       service buyback is calculated.

       If the service buyback is for the balance of service not purchased under a
       Pension Transfer Agreement (PTA), please clearly indicate this on the form. You
       must forward the completed form within six months of notification of the cost to
       purchase the service not credited by the transfer.

       An election for the balance of PTA service made after this deadline must be
       forwarded within 30 days of signing. For further details refer to Service not
       credited by the PTA found at: http://www.tpsgc-
       pwgsc.gc.ca/pension/act/transfr/index-eng.html




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       In order to surrender your Canadian Forces or Royal Canadian Mounted Police
       pension, you must complete the following form, keep a copy for your records and
       send the original to the address indicated on the form.

       Election to Surrender Benefits (PWGSC-TPSGC 2092 in Appendix B)

       Please note that a different form is required if you wish to buy back prior Federal
       Public Service for which you received a Transfer Value. You must complete the
       following form and forward it to the address indicated on the form.

       Election Form for Transfer Value Service (PWGSC-TPSGC 2005 in Appendix B)

       It is important to note that there is a limited period of time within which you must
       make your option to buy back this service and the cost and method of payment is
       different. Please consult the Pension Centre for more details (see Appendix A –
       Contact us).

       A valid election to purchase additional pensionable service made under the
       terms of the Public Service pension plan is a legally binding agreement that
       can only be revoked under very exceptional circumstances. You will receive
       written notification in the form of an Elective Service Notice (PWGSC-TPSGC
       2097) once your request to buy back service has been approved.

       3.4. Payments

              3.4.1. Lump Sum Payments versus Monthly Instalments

              You may pay for your service buyback

              •   In a lump sum by paying the full amount within 30 days of the date of
                  signing the election form;
              •   By monthly instalments; or
              •   By a combination of these two methods.

              The instalment method includes interest and mortality charges. In the
              event of your death, the election is considered paid in full, with the
              exception of any payments in default (missed payments) to that point in
              time. As the instalment method is more costly than paying by a lump sum
              payment, you should compare the two costs before making a decision on
              how you wish to pay for the service buyback.


              3.4.2. Cash Lump Sum Payments

              Cash lump sum payments received within 30 days of the date you signed
              your election will directly reduce the cash cost. If your lump sum payment
              is not received within that 30 day period, it is assumed that you wish to
              pay by monthly instalments from your salary. Any lump sum amount
              received after the 30 day period will not be applied to directly reduce the



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              cash cost but will be applied to the balance owing at the time the payment
              is made.

              If the total period of service you chose to buy back is for post-1989
              service, the entire amount of the cash payment is fully tax deductible and
              must be claimed in the tax year it was paid. However, if any or all of the
              lump sum cash payment is in respect of pre-1990 service, the tax
              deductibility is limited. Before making a large lump sum cash
              payment, ensure that you understand the tax deductibility limits
              applicable to cash payments. Refer to the Section 2.4. of this
              document for further information on tax implications.

              Cash (or money order) payments must be made payable to the Receiver
              General for Canada. If accompanying the election form, it must be sent
              directly to the address indicated on that form.

              Payments not accompanying the election form must be forwarded directly
              to the Pension Centre.

              3.4.3. Direct Transfer from a Registered Retirement Savings Plan
              (RRSP)

              You may pay for prior service by means of transferring RRSP
              contributions. In order to do so without having income tax deducted, you
              must complete a Direct Transfer under subsection 146.3(14.1) or
              paragraph 146(16)(a) or 146.3(2)(e) (T2033 in Appendix B)
              (http://www.cra-arc.gc.ca/E/pbg/tf/t2033/) for RRSP transfers. This form is
              also available from your financial institution or the Canada Revenue
              Agency (CRA).

              If you transfer funds from an RRSP to buy back service, you must
              complete Area 1 of the Direct Transfer under subsection 146.3(14.1) or
              paragraph 146(16)(a) or 146.3(2)(e) of form T2033 and forward it along
              with the Election Form for Elective Pensionable Service (PWGSC-
              TPSGC 3006 in Appendix B) to the address indicated on that form.
              When completing the form, please provide your current address, the
              RRSP account identifier and where the form indicates "in cash" or "in
              kind", select "in cash".

              If your cheque, money order or Direct Transfer under subsection
              146.3(14.1) or paragraph 146(16)(a) or 146.3(2)(e) form is not
              received within 30 days from the date you sign the election form, the
              Pension Centre will assume you have opted to pay by monthly
              instalments.

              3.4.4. Direct Transfer From Your Former Pension Plan

              You may also pay for prior service through a direct transfer from your
              former pension plan. In order to do so without having income tax
              deducted, you must complete a Record of Direct Transfer of a Single
              Amount form (T2151 in Appendix B)

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              (http://www.cra-arc.gc.ca/E/pbg/tf/t2151/). This form is available from the
              administrator of your former pension plan or CRA.

              The T2151 should be forwarded along with the Election Form for
              Elective Pensionable Service (PWGSC-TPSGC 3006 in Appendix B)
              to the address indicated on that form. Upon receipt of your election
              form, the Pension Centre will contact you concerning this payment option.

              Registered funds transferred into the Public Service pension plan cannot
              be certified as “locked-in" in accordance with the federal or provincial
              pension benefits standards legislation. Transferred funds are locked-in
              according to the provisions of the Public Service pension plan and not
              that of other pension benefits standards legislation. For this reason,
              some pension plan administrators and financial institutions may be
              reluctant or unwilling to transfer your funds. Contact your former employer
              or pension plan administrator in order to obtain more information on their
              transfer requirements and the amount of funds available. The Pension
              Centre can provide details of the Public Service pension plan lock-in
              provisions. Please note that the amount available for transfer to buy back
              service may not be the same as the amount available for transfer under
              the terms of a Pension Transfer Agreement (PTA).

              3.4.5. Monthly Instalments

              As indicated, the monthly instalment method is more costly than paying
              by lump sum because of added interest and mortality charges.

              If you pay by monthly instalments, deductions must be made by the end
              of the month in which your election form is received. The first deduction
              may be larger than the regular monthly amount if deductions are not
              started on time. Also, proof of age is required when monthly instalments
              have been chosen as the payment method. If satisfactory proof of age is
              not on file when you sign your election form, the Pension Centre will
              request that you submit one. A letter will be sent to you outlining the
              requirements, the time limit for submitting the proof of age documents and
              the consequences of not supplying the required documents within the
              prescribed time.

              When on Leave Without Pay (LWOP), your payments should be sent
              directly to the Pension Centre using the form Service Buyback Transmittal
              for Plan Member on Leave Without Pay (PWGSC-TPSGC 570 in
              Appendix B). Interest will be charged on defaulted payments.

              If you retire prior to paying the cost of your service buyback in full, the
              required instalments will be deducted from your monthly pension benefit
              once your service buyback has been finalized. If your pension benefit is
              not payable immediately (within 30 days of termination of employment)
              you must remit your elective service payments directly to the Pension
              Centre; otherwise, interest will be charged on any defaulted payments. A
              default, which occurs over an extended period of time, will result in
              significantly higher minimum monthly payments.

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              After choosing monthly instalments, you may decide later to amend your
              method of payment. You may make a lump sum payment at any time. It
              will be applied to shorten your repayment period or, at your request,
              reduce your monthly instalment amount. You may also increase your
              monthly instalment amount at any time, which will shorten your
              repayment period. The payment methods are flexible and you may
              choose any one or a combination of these options. However, you
              normally cannot reduce your monthly payments below the minimum
              monthly instalment amount nor can you extend the repayment period
              beyond the maximum permitted.

       3.5. Complaint Escalation Process

       The Pension Centre has an internal complaint escalation process, which ensures
       that if the employee responsible for the case cannot resolve a concern, it is
       automatically raised to the next level for consideration. If necessary, please refer
       to the Complaint Escalation Process at the following Internet address:
       http://www.tpsgc-pwgsc.gc.ca/pension/act/rachat-buyback/plaintes-complnts-
       eng.html




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                            APPENDIX A - Contact us

We may have already answered your questions! Your Public Service Pension and
Benefits Portal is the one-stop shop for accurate pension and insurance benefits
information and tools. Visit www.pensionandbenefits.gc.ca today.

We invite you to contact us using your preferred means of communication. For questions
about your insurance benefits, please contact your Compensation Advisor.

     A)   E-mail
     B)   Telephone
     C)   Facsimile
     D)   Mail

A) E-mail

Please e-mail your comments to: pensioncentre.centredespensions@pwgsc-tpsgc.gc.ca

Disclaimer: For reasons of security and privacy, please do not send any personal
information such as your Social Insurance Number (SIN), home or business address, or
departmentally-assigned case or file numbers. In addition, we cannot forward e-mail
messages on your behalf and cannot accept and process changes of address.


B) Telephone

Toll free: 1-800-561-7930

Monday to Friday
8:00 a.m. to 4:00 p.m. (your local time)

Outside Canada and the United States: 0-506-533-5800 (collect calls accepted)
Telephone Teletype (TTY): 0-506-533-5990 (collect calls accepted)

Monday to Friday
8:00 a.m. to 8:00 p.m. (Atlantic time)


C) Facsimile

1-418-566-6298

Note: Always include your pension number or Personal Record Identifier (PRI) when
providing information by facsimile.




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D) Mail

Public Works and Government Services Canada
Public Service Pension Centre – Mail Facility
150 Dion Blvd
PO Box 8000
Matane QC G4W 4T6

Note: Always include your pension number or Personal Record Identifier (PRI) when
writing.


Service Standards

Service standards are established for our different operational services. In order to
become aware of these service standards, visit:
http://www.tpsgc-pwgsc.gc.ca/pension/retr/objectfs-goals-eng.html




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                             APPENDIX B – Forms

Disclaimer: The forms listed below are the property of the Compensation Sector and
the Canada Revenue Agency, they are provided solely for the convenience of the users
of this package.

Service Buyback Payment Transmittal for Plan Member on Leave Without Pay
(PWGSC-TPSGC 570)
  http://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/form/570.pdf

Election Form for Elective Pensionable Service (PWGSC-TPSGC 3006)
  http://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/form/3006.pdf


Election Form for Transfer Value Service (PWGSC-TPSGC 2005)
  http://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/form/2005.pdf


Pensionable Employment Questionnaire (PWGSC-TPSGC 2069)
  http://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/form/2069.pdf


Election to Surrender Benefits (PWGSC-TPSGC 2092)
  http://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/form/2092.pdf


Direct Transfer under subsection 146.3(14.1) or paragraph 146(16)(a) or 146.3(2)(e)
(T2033)
   http://www.cra-arc.gc.ca/E/pbg/tf/t2033/


Record of Direct Transfer of a Single Amount form (T2151)
  http://www.cra-arc.gc.ca/E/pbg/tf/t2151/




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                                                         Clear Data - Effacer les données
                       Public Works and Government       Travaux publics et Services                          Protected "B" when completed
                       Services Canada                   gouvernementaux Canada                                Protégé « B » lorsque rempli

                        SERVICE BUYBACK PAYMENT TRANSMITTAL FOR
                            PLAN MEMBER ON LEAVE WITHOUT PAY
                  BORDEREAU DE TRANSMISSION DE PAIEMENT POUR RACHAT DE
                 SERVICE POUR LE PARTICIPANT AU RÉGIME EN CONGÉ NON PAYÉ
Provision of the information requested on this document is voluntary.        La communication des renseignements demandés dans ce document
This information is being collected in accordance with the Public Service    est facultative. Ces renseignements sont recueillis en vertu de la Loi sur
Superannuation Act (PSSA) for the purpose of remitting service               la pension de la fonction publique (LPFP) aux fins de transmettre des
buyback payments while on leave without pay. This personal                   paiements relatifs à un rachat de service durant un congé non payé.
information will be stored in Personal Information Bank Number PWGSC         Les renseignements personnels seront versés au fichier de
PCE 702 and will be protected, used and disclosed in accordance with         renseignements personnels numéro TPSGC PCE 702 et seront protégés,
the Privacy Act. Under this act, employees have the right to request         utilisés et divulgués conformément aux dispositions de la Loi sur la
access to their personal information and to request corrections should       protection des renseignements personnels. Aux termes de cette loi, les
they believe the information contains errors or omissions. Personal          employés ont le droit d'exiger qu'on leur communique les
information provided about another individual may be accessible to that      renseignements personnels les concernant et de faire corriger les
person under the Privacy Act. The records will be retained by the            données incomplètes ou erronées. Les renseignements personnels
department for two years following the last administrative action, and       fournis au sujet d'une autre personne peuvent être communiqués à
then will be destroyed.                                                      celle-ci en vertu de la Loi sur la protection des renseignements
                                                                             personnels. Le ministère conservera les renseignements pendant deux
                                                                             ans suivant le dernier changement administratif, après quoi ils seront
                                                                             détruits.

This form must be completed electronically. If not                           Ce formulaire doit être rempli électroniquement. Si
possible, please use dark ink and capital letters.                           impossible, veuillez le remplir à l'encre foncée et en
                                                                             lettres majuscules.
PLAN MEMBER'S PERSONAL INFORMATION
RENSEIGNEMENTS PERSONNELS DU PARTICIPANT AU RÉGIME
 Surname - Nom                                                                                                PRI - CIDP




 Given Names - Prénoms                                                                                        Pension No. - N° de pension




 Date of Birth (YYYYMMDD) - Date de naissance (AAAAMMJJ)                      Preferred Telephone No. - N° de téléphone de préférence




 Home Address - Adresse du domicile                                                                           Apt. No. - N° d'apt.




 City - Ville                                                                                                 Province




 Postal Code - Code postal                        Country - Pays




 Email address (optional) - Adresse électronique (facultative)




FOR OFFICE USE ONLY                   Form No.
                                                                                              Case No.
À L'USAGE DU                             N° de                              2 0 0 6           N° de cas
BUREAU SEULEMENT                     formulaire

                   PWGSC-TPSGC 570 (02/2009)
                                        FOR OFFICE USE ONLY - À L'USAGE DU BUREAU SEULEMENT
          Form No. - N° de formulaire               PRI - CIDP                     Pension No. - N° de pension

                                  2 0 0 6


Carefully read instructions before completing.                     Lire les instructions attentivement avant de remplir.


This form should be used by plan members during a                  Ce formulaire devrait être utilisé par le participant au
leave without pay period to remit service buyback                  régime durant un congé non payé afin de transmettre
payments to the Superannuation, Pension Transition                 des paiements relatifs à un rachat de service au
and Client Services Sector.                                        Secteur des Pensions de retraite, Regroupement des
                                                                   pensions et Services à la clientèle.

This form provides information necessary for accounting            Ce formulaire fournira l'information nécessaire aux fins
purposes.                                                          de comptabilité.

Cheques must be made payable to the Receiver General               Les chèques doivent être libellés à l'ordre du Receveur
for Canada and forwarded to:                                       général du Canada et envoyés au :

  Superannuation, Pension Transition                                 Secteur des Pensions de retraite, Regroupement
  and Client Services Sector                                         des pensions et Services à la clientèle
  PO Box 5010                                                        CP 5010
  Shediac NB E4P 9B4                                                 Shediac NB E4P 9B4



                 Monthly Deduction Amount
            Montant de la retenue mensuelle

                             Amount of Cheque
                             Montant du chèque

                                                                      (M   Y-A)                   (M   Y-A)
This payment covers the following month(s):               From                         To
  Ce paiement couvre le(s) mois suivant(s) :              Du                           Au

                  PWGSC-TPSGC 570 (02/2009)
                Instructions                               Clear Data - Effacer les données                  Instructions for Printing - Aide à l'impression
                         Public Works and Government            Travaux publics et Services                              Protected "B" when completed
                         Services Canada                        gouvernementaux Canada                                    Protégé « B » lorsque rempli


                               ELECTION FORM FOR ELECTIVE PENSIONABLE SERVICE
                                FORMULAIRE POUR SERVICE ACCOMPAGNÉ D'OPTION

Provision of the information requested on this document is voluntary. This            La communication des renseignements demandés dans ce document est
information is being collected for the purpose of the administration of the Public    facultative. Ces renseignements sont recueillis aux fins de l'administration de
Service Superannuation Act (PSSA) and is essential to making a decision directly      la Loi sur la pension de la fonction publique (LPFP) et sont essentiels pour
affecting you. Refusal to respond may result in you not paying for elective           prendre une décision qui vous concerne directement. Un refus de répondre peut
pensionable service. This information will be stored in Personal Information Bank     vous priver de payer pour du service accompagné d'option. Ces renseignements
number PWGSC PCE 702. It is protected from disclosure to unauthorized persons         seront versés au fichier de renseignements personnels numéro TPSGC PCE 702.
or agencies pursuant to the provisions of the Privacy Act. Under the Act you have     Ils sont protégés contre toute divulgation à des personnes ou à des organismes
the right to request access to your personal information, held by a federal           non autorisés, conformément aux dispositions de la Loi sur la protection des
government institution, and to request corrections should you believe the             renseignements personnels. Aux termes de ladite loi, vous avez le droit de vous
information contains errors or omissions.                                             faire communiquer les renseignements personnels vous concernant, conservés
                                                                                      par une institution du gouvernement fédéral et de demander des corrections si,
                                                                                      selon vous, ils sont erronés ou incomplets.


Please complete this form in dark ink using capital letters. If                       Veuillez remplir ce formulaire en lettres majuscules à l'encre
possible, complete form electronically. This form must be                             foncée.        Si    possible,    remplissez   le   formulaire
printed on legal size paper (8 1/2" x 14"). Please refer to                           électroniquement. Ce formulaire doit être imprimé sur du
printing instructions below.                                                          papier grand format (8 1/2" x 14"). Veuillez consulter les
                                                                                      instructions pour l'impression ci-dessous.
PLAN MEMBER'S PERSONAL INFORMATION
RENSEIGNEMENTS PERSONNELS DU PARTICIPANT AU RÉGIME
 Surname - Nom                                                                                                            PRI - CIDP




 Given Names - Prénoms                                                                                                    Pension No. - N° de pension




                                                                                                                          Date of Birth (YYYYMMDD)
 Home Address - Adresse du domicile                                                                                       Date de naissance (AAAAMMJJ)




 Apt. No. - N° d'apt.                  City - Ville                                                                                      Province




 Postal Code - Code postal             Country - Pays                                                                 Home Tel. No. - N° de tél. à domicile




 Email address (optional) - Adresse électronique (facultative)




FOR OFFICE USE ONLY                       Control No.
                                                                                                          Case No.
À L'USAGE DU BUREAU                            N° de                                 2 0 0 6              N° de cas
SEULEMENT                                   contrôle


Carefully read instructions before completing.                                        Lire les instructions attentivement avant de remplir.
Retain a copy for your records and forward the original by                            Conserver un exemplaire pour vos dossiers et faire parvenir
registered mail to:                                                                   l'original par courrier recommandé à :
    Public Works and Government Services Canada                                            Travaux publics et Services gouvernementaux Canada
    PO Box 8000                                                                            CP 8000
    Matane QC G4W 4T6                                                                      Matane QC G4W 4T6
Work Telephone No. - N° de téléphone - travail            Sex - Sexe                                           Date Mailed - Posté le            (Y-A M D-J)



I hereby elect to pay for this service for pension purposes.                          Je choisis de racheter les périodes de service ci-dessous
                                                                                      aux fins de pension.
 * Service  Part-time
                                                                                                                                  From                   To
Type Code Yes or No                                       Particulars Concerning Employer                                          Du                    Au
Code type Temps partiel                                   Précisions concernant l'employeur
de service oui ou non                                                                                                        (Y-A M D-J)            (Y-A M D-J)




* See Instructions for Service Type codes - Voir les instructions pour les codes de type de service


                     PWGSC-TPSGC 3006 (12/2008)
                                      FOR OFFICE USE ONLY - À L'USAGE DU BUREAU SEULEMENT
               Control No. - N° de contrôle                  PRI - CIDP                               Pension No. - N° de pension

                                         2 0 0 6


Pensionable Service Under the Royal Canadian Mounted Police or Canadian Forces Pension Acts
Service ouvrant droit à pension aux termes des Lois sur la Pension de la gendarmerie royale du Canada ou des Forces Canadiennes
                             Regimental No. - N° matricule      Date of Discharge            (Y-A M D-J)
                                                                                                                         From                  To
     RCMP            CF                                         Date de démobilisation
     GRC             FC                                                                                                   Du                   Au
                                                                                                                     (Y-A M D-J)          (Y-A M D-J)




METHOD OF PAYMENT: I further elect to make my                                    MODE DE PAIEMENT : Je m'engage aussi à verser mes
contributions in the following manner.                                           cotisations de la façon suivante.
PAYABLE TO THE RECEIVER GENERAL FOR CANADA:
FAIT À L'ORDRE DU RECEVEUR GÉNÉRAL DU CANADA :
     Minimum Monthly Deduction (See Agreement 2)             OR              Monthly Deduction of
     Versement mensuel minimum (Voir convention 2)           OU              Versement mensuel de    $
AND / OR
ET / OU
Enclosed is:         Lump Sum of                                                  Cheque             Draft               Money Order
Ci-joint :           Montant forfaitaire de   $                                   Chèque             Traite              Mandat
                                                                                  RRSP Transfer                  Registered Pension Plan (RPP) Transfer
                                                                                  Transfert d'un REER            Transfert d'un Régime de pension agréé

IMPORTANT: See Note 4 "Lump Sum Payment" and Note 5                              IMPORTANT : Voir la remarque 4 « Paiement forfaitaire » et la
"Monthly Deduction" from the instruction page.                                   remarque 5 « Versement mensuel » à la page des instructions.


AGREEMENT                                                                        CONVENTION
1. Where the plan member makes a lump sum payment:                               1. Lorsque le participant verse un montant forfaitaire :
   If in the opinion of the Director General, Superannuation, Pension               Si de l'avis du directeur général au Secteur des Pensions de retraite,
   Transition and Client Services Sector (SPTCSS), the PSSA and                     Regroupement des pensions et Services à la clientèle (SPRRPSC),
   Regulations made thereunder require a larger contribution to be                  la LPFP et le Règlement afférent exigent une cotisation
   made than the amount of the lump sum payment that I have made, I                 supérieure au montant que j'ai versé, j'accepte, sur demande, de
   agree, upon request, to pay the difference between these two                     verser la différence entre ces deux montants, suivant l'un ou l'autre
   amounts in accordance with either of the methods of payment                      des modes de paiement mentionnés ci-dessus.
   mentioned above.
   I understand that if the lump sum paid is greater than the contribution          Je comprends que si le montant forfaitaire que j'ai versé est
   required, a refund will be made.                                                 supérieur à la cotisation requise, un remboursement sera effectué.
2. Where the plan member chooses to pay by monthly deductions:                   2. Lorsque le participant au régime choisi de payer par versement
   The monthly payment in respect of the periods of service selected                mensuel : Le paiement mensuel à l'égard des périodes de service
   herein will not be less than the amount stated above, unless                     précisées dans les présentes ne sera pas inférieur au montant
   "minimum monthly payment" is indicated.                                          indiqué ci-dessus à moins qu'un « paiement mensuel minimum » ne
                                                                                    soit précisé.
   It is important to note that if the plan member specifies both a                 Il est important de noter que si le participant au régime spécifie un
   monthly deduction amount and checks minimum monthly payments,                    montant de versement mensuel et coche également la case de
   the SPTCSS will apply the specified amount if it is greater than the             paiement mensuel minimum, le SPRRPSC déduira le montant
   minimum required.                                                                mensuel spécifié s'il est plus élevé que le paiement minimum requis.

I have read and understand the attached instructions.                             J'ai lu et compris les instructions ci-jointes.




                          Signature of Plan Member - Signature du participant au régime                        Date (Y-A M D-J)
                        PWGSC-TPSGC 3006 (12/2008)
                                                                                 Form - Formulaire


                   INSTRUCTIONS TO PLAN MEMBER                                              INSTRUCTIONS À L'INTENTION DU PARTICIPANT AU RÉGIME

1. COMPLETION OF THE FORM                                                                  1. COMMENT REMPLIR LE FORMULAIRE
Care should be taken when completing this form since, under most circumstances, an         Il faut remplir le formulaire avec grand soin, car, dans la plupart des cas, l'option
election is a binding, irrevocable agreement. Please ensure that the dates of the          exercée est considérée comme une entente exécutoire et irrévocable. Veuillez vous
service which you enter are complete and accurate and only apply to periods of             assurer que les dates inscrites soient complètes et exactes et qu'elles correspondent
service that you wish to count.                                                            uniquement aux périodes de service que vous voulez faire compter.

You should complete all sections of the form except where indicated "For Office Use        Vous devez remplir toutes les sections du formulaire sauf lorsque indiqué « Pour
Only".                                                                                     l'usage de l'administration seulement ».

The following service type codes are needed to complete the form.                          Les codes de type de service suivants sont nécessaires pour compléter le formulaire.
    Service Type Codes                                                                     Codes - type de service
    1 - Past Service in the Public Service - Indicate department, agency,                  1 - Service antérieur dans la fonction publique - Indiquez le ministère,
         address, etc.                                                                         organisme, adresse, etc.
    2 - Pensionable Employment other than Public Service - Indicate name and               2 - Service ouvrant droit à pension à l'extérieur de la fonction publique - Indiquez
         address of employer (see note 5 below prior to completing)                            le nom et l'adresse de l'employeur (voir la note 5 ci-dessous avant de remplir)
    3 - Correctional Service or Air Traffic Control Service - Indicate if operational or   3 - Service correctionnel ou service du contrôle de la circulation aérienne
         non-operational service in "Particulars Concerning Employer" column                  - Indiquez à la colonne « Précisions concernant l'employeur » s'il
                                                                                               s'agit de service opérationnel ou non opérationnel

2. FORWARDING OF FORM                                                                      2. TRANSMISSION DU FORMULAIRE
After completing the form, retain a copy for your records and forward the original         Après avoir rempli le formulaire, conservez un exemplaire pour vos dossiers et faites
immediately to:                                                                            parvenir l'original immédiatement à :
     Public Works and Government Services Canada                                               Travaux publics et Services gouvernementaux Canada
     PO Box 8000, Matane QC G4W 4T6                                                            CP 8000, Matane QC G4W 4T6
Use of registered mail is recommended. If sent by registered mail, the receipt of          Il est recommandé de transmettre le formulaire par courrier recommandé. Si vous
registration should be kept for your records. The date on which this form is mailed        transmettez le formulaire par courrier recommandé, le reçu d'inscription devrait être
must be indicated in the space provided on page 1.                                         placé dans vos dossiers. La date à laquelle ce formulaire est posté doit être inscrite
                                                                                           dans l'espace prévu à cette fin à la page 1.

If you are making an election within one year from the date of issue of your               Si vous exercez une option dans l'année qui suit la date d'émission de votre
Notification of Plan Membership, PWGSC-TPSGC 2018, the completed election                  Avis concernant la participation au régime, TPSGC-PWGSC 2018, le formulaire
form must be forwarded within that year.                                                   d'option rempli doit être envoyé avant la fin de l'année en question.

In the case of an election made after this time, the completed election form must          Si l'option est exercée après ce délai, le formulaire rempli doit être envoyé dans
be forwarded within one month of signing the form. Failure to send the form                le mois qui suit la date de sa signature. Si le formulaire n'est pas envoyé dans
within the prescribed time will result in the election being declared invalid.             le temps prescrit, l'option sera déclarée non valide.

3. VALIDATION OF ELECTION                                                                  3. VALIDATION DE L'OPTION
Medical Examination - Certain elections require a medical examination in order to be       Examen médical - Certaines options exigent un examen médical afin d'être valides.
valid. Medical examinations must be undergone within 90 days prior to or 6 months          Les examens médicaux doivent être subis dans les 90 jours avant ou 6 mois après le
after making the election. The required medical forms to be completed by your              choix d'option. Les formulaires à remplir par votre médecin doivent être envoyés au
physician should be forwarded to the specified Regional Medical Services Office            bureau régional des services médicaux (Santé Canada) comme indiqué sur les
(Health Canada).                                                                           formulaires d'examen médical.

Service Verification - Official verification of service is required to validate any        Vérification du service - Pour qu'une option soit valide, il faut que les périodes de
election. This process may necessitate time. If you are asked to help verify this          service aient été officiellement vérifiées. Cela peut prendre du temps. Si l'on sollicite
service, your cooperation is essential. The initiation of deductions does not indicate     votre aide pour la vérification du service, votre collaboration est essentielle. Le début
acceptance of this service.                                                                des retenues ne signifie pas que le service ait été accepté.

4. LUMP SUM PAYMENT - Elective Service Paid in Full                                        4. PAIEMENT FORFAITAIRE - Service accompagné d'option payé en entier
The plan member is responsible for completing the appropriate documents and                Le participant est responsable de remplir les documents appropriés et s'assurer que
ensuring the funds are sent to Public Works and Government Services Canada.                les fonds sont envoyés à Travaux publics et Services gouvernementaux Canada.
When you are paying the election in full or in part by means of a lump sum payment,        Lorsque vous payez l'option en entier ou en partie au moyen d'un paiement forfaitaire,
the payment must be received by:                                                           le paiement doit être reçu à :
     Public Works and Government Services Canada                                               Travaux publics et Services gouvernementaux Canada
     PO Box 8000, Matane QC G4W 4T6                                                            CP 8000, Matane QC G4W 4T6
within 30 days of the date of the election.                                                dans les 30 jours qui suivent la date d'option.

If the payment is not received within 30 days of the date of the election, the             Si le paiement n'est pas reçu dans les 30 jours qui suivent la date d'option, le
Superannuation, Pension Transition and Client Services Sector will authorize the           Secteur des Pensions de retraite, Regroupement des pensions et Services à la
commencement of deductions at the minimum monthly amount. Cash payments                    clientèle autorisera des retenues mensuelles minimales. Les paiements comptant
received after 30 days will be applied to the cost of the election calculated as of        reçus après 30 jours seront appliqués au coût de l'option calculée à la date où
the date they are received.                                                                les paiements sont reçus.

5. IMPORTANT NOTE                                                                          5. REMARQUE IMPORTANTE
Pensionable Employment - Service must have occurred "immediately prior" to                 Emploi ouvrant droit à pension - Comme il est indiqué dans la loi, la période de
becoming employed in the Public Service as outlined in the legislation. Any right to a     service doit avoir eu lieu « immédiatement avant » l'entrée en service dans la fonction
continuing pension benefit as a result of this service must be surrendered prior to the    publique. Le droit, s'il en est, à une pension permanente au titre de ce service doit
making of an election.                                                                     être cédé avant d'exercer une option.

Elections for past periods of pensionable employment are limited to service which was      Les options exercées relativement à des périodes antérieures d'emploi ouvrant droit à
accrued in a pension plan registered under the (Canadian) Income Tax Act.                  pension se limitent au service accumulé dans un régime de pension enregistré en
                                                                                           vertu de la Loi (canadienne) de l'impôt sur le revenu.

Past Service Pension Adjustment (PSPA) - A PSPA must be calculated for all                 Facteur d'équivalence pour services passés (FESP) - Il faut calculé le facteur
elections in respect of post 1989 service. Where the Canada Revenue Agency does            d'équivalence à l'égard de toute option exercée pour du service postérieur à 1989.
not approve the PSPA, the election will be invalid.                                        Lorsque l'Agence du revenu du Canada n'approuve pas le FESP, l'option sera
                                                                                           annulée.

Monthly Deductions - If you choose to pay for your election by means of monthly            Versements mensuels - Si vous choisissez de payer votre service accompagné
deductions, please note that interest and mortality charges will be applicable and will    d'option par voie de versements mensuels, veuillez prendre note que des intérêts ainsi
be included in the cost. The first payment is due at the end of the month in which the     que des frais d'assurance-vie s'appliqueront et seront inclus dans le coût. Le premier
election is received by Public Works and Government Services Canada. Full or               paiement est dû à la fin du mois au cours duquel l'option est reçue par Travaux publics
partial default of the monthly deduction(s) may result if there is a delay in commencing   et Services gouvernementaux Canada. S'il y a un délai à initier le paiement mensuel,
the correct monthly payment, and it may be necessary to increase your monthly              le montant pourrait être en souffrance (partiellement ou totalement). Dans ce cas, il
deduction to cover the default.                                                            sera nécessaire d'augmenter le paiement mensuel pour combler le montant en
                                                                                           souffrance.
Please note that there may be additional information that pertains to your specific        Veuillez noter que des renseignements             additionnels   pourraient   s'appliquer
situation.                                                                                 spécifiquement à votre situation.

The Pension and Benefits website (www.pensionandbenefits.gc.ca) is an excellent            Le site de la pension et des avantages sociaux (www.pensionetavantages.gc.ca) est
source of information on elective service. We recommend you consult it before              une excellente source d'information sur les rachats de service. Nous vous
signing this agreement.                                                                    recommandons de le consulter avant la signature du présent accord.




PWGSC-TPSGC 3006 (12/2008)
                                                      Form - Formulaire




          INSTRUCTIONS FOR PRINTING                                       INSTRUCTIONS POUR L'IMPRESSION

This form MUST be printed on legal size paper                    Ce formulaire DOIT être imprimé sur du papier grand
(8½” x 14”) whenever possible. If your printer cannot print      format (8½" x 14") si possible. Si votre imprimante n'a
on legal size paper, these instructions must be followed         pas la capacité d'imprimer sur du papier grand format,
in order to print on letter size paper (8½” x 11”). If these     veuillez suivre les instructions ci-dessous afin d'imprimer
instructions are not followed, the form image may be cut         sur du papier format lettre (8½" x 11"). Si vous ne suivez
off, and the form will be rejected.                              pas ces instructions, l'image du formulaire pourrait être
                                                                 coupée, et le formulaire sera rejeté.

INSTRUCTIONS                                                     INSTRUCTIONS

  - Click on the “Print” icon or select “File”, “Print” from       - Cliquer sur l'icône « Imprimer » ou, à partir de la
  the Menu bar.                                                    barre de menus, choisir « Fichier », « Imprimer ».

  - The “Print” dialogue box will open.                            - La boîte de dialogue « Imprimante » s'ouvrira.

  - Go to the “Page Handling” option box and select “Fit           - Trouver la case d'option « Gestion de la page » et
  to Printer Margins” from the “Page Scaling” drop                 sélectionner l'option « Réduire selon marge de
  down menu.                                                       l'imprimante » du menu déroulant « Mise à
                                                                   l'échelle ».

  NOTE: The location of this option may differ from one            NOTA : L'endroit où se situe cette option peut varier
  printer to the other.                                            d'une imprimante à l'autre.

  - Click “OK” to print the form.                                  - Cliquer sur « OK » pour imprimer le formulaire.

NOTE: If your printer is capable of printing on legal size       NOTA : Si votre imprimante a la capacité d'imprimer sur
paper, make sure that the proper paper size (legal) is           du papier grand format, assurez-vous que le bon format
selected in the “Print” dialogue box. If not, select the         de papier (grand format) est sélectionné dans la boîte de
paper size manually.                                             dialogue. Sinon, sélectionner le format manuellement.
                                                                                   Clear Data - Effacer l'information
          Public Works and Government         Travaux publics et Services                                                            Protected "B" when completed
          Services Canada                     gouvernementaux Canada                                                                  Protégé « B » lorsque rempli
          Public Service                      Administration de la Loi
          Superannuation Act                  sur la pension
          Administration                      de la fonction publique                                                                                  Instructions


                               ELECTION FORM FOR TRANSFER VALUE SERVICE
              FORMULAIRE POUR OPTION DE RACHAT DE SERVICE VISÉ PAR UNE VALEUR DE TRANSFERT

Read instructions carefully before completing                                    Lire les instructions attentivement avant de remplir
Part A - To be completed by the personnel office (when completed,                Partie A - Doit être remplie par le bureau du personnel (ensuite, faire
         forward all copies to the contributor.)                                            parvenir le tout au cotisant.)
Department - Ministère                         Branch or Service - Direction ou Service     PRI - CIDP                              Superannuation No.
                                                                                                                                    N° de pension de retraite


Address of Personnel Office - Adresse du bureau du personnel                                Telephone No. - N° de téléphone         Facsimile No. - N° de télécopieur


                                                                                            Pay Office          Dept. - Min.        PL No. - N° LP Date Mailed
                                                                                            Bur. de paye                                                 Posté le
                                                                                                                                                           Y-A      M    D-J



Part B - To be completed by the contributor (retain copy 3 and                 Partie B - Doit être remplie par le cotisant (conserver l'exemplaire 3 et
         forward remaining copies by registered mail to your                              faire parvenir les autres exemplaires par courrier
         personnel office or to the Superannuation, Pension                               recommandé à votre bureau du personnel ou au Secteur des
         Transition and Client Services Sector).                                          Pensions de retraite, Regroupement des pensions et
                                                                                          Services à la clientèle).
Surname - Nom                                             Given Name(s) - Prénom(s)                         Date of Birth - Date de naissance   Sex - Sexe
                                                                                                                       Y-A           M           D-J


Complete Home Address - Adresse complète du domicile                                        Telephone No. - N° de téléphone
                                                                                            Home - Domicile :                       Work - Travail :



                                                                                            Date Mailed              Y-A        M        D-J

                                                                                            Posté le

I hereby elect to pay to reinstate the full period(s) of my transfer value             Je choisis de rétablir entièrement la ou les periode(s) de service visée(s)
service.                                                                               par une valeur de transfert.
                                                                             OR / OU
I hereby elect to pay to reinstate a portion of my transfer value service              Je choisis de rétablir uniquement la partie du service qui correspond :
corresponding to the amount of:

$                       and/or the following period of service:          years         à une somme de                           $ ou à une période de                   années
and              days                                                                  et de          jours.

NOTE: The Superannuation, Pension Transition and Client Services                       REMARQUE : Le Secteur des Pensions de retraite, Regroupement
Sector will only reinstate the most recent period(s) of pensionable                    des pensions et Services à la clientèle ne rétablira que la ou les
service corresponding to the amount received.                                          périodes de service les plus récentes; en fonction de la somme
                                                                                       versée.

IMPORTANT: See note 4 "PAYMENT METHOD" on the instructions                             IMPORTANT : Voir la remarque 4 « MODE DE PAIEMENT » à la page
page.                                                                                  des directives.

AGREEMENT                                                                              CONVENTION

I hereby elect to pay to reinstate past transfer value service in a lump               Je m'engage par la présente à verser une somme forfaitaire pour rétablir le
sum payment. If the amount received is less than the full cost required to             service antérieur visé par une valeur de transfert. Si le montant versé est
reinstate the full previous transfer value service, then I agree that only a           inférieur au coût total demandé pour racheter tout le service antérieur visé
portion of the service will be reinstated.                                             par une valeur de transfert, j'accepte que seulement une partie du service
                                                                                       soit rétablie.

I understand that if the lump sum paid is greater than the contribution                Je comprends que si je verse une somme forfaitaire supérieure à la
required, a refund will be made.                                                       cotisation demandée, un remboursement sera fait.
Signature of Contributor - Signature du cotisant                                                                           Election Date - Date d'exercise de l'option
                                                                                                                                         Y-A      M         D-J


Part C - To be completed by the personnel office (retain copy 2                  Partie C - Doit être remplie par le bureau du personnel (conserver
         and send copy 1 to the Superannuation, Pension Transition                          l'exemplaire 2 et envoyer l'exemplaire 1 au Secteur des
         and Client Services Sector, P.O. Box 5010, Shediac,                                Pensions de retraite, Regroupement des pensions et Services à
         N.B. E4P 9B4                                                                       la clientèle, C.P. 5010, Shediac (N.-B.) E4P 9B4
Date of Receipt                 Y-A      M       D-J      Registration No.                                              Initials
Date de réception                                         N° d'inscription                                              Initiales
PWGSC-TPSGC 2005 (04/2005)         1 - Superannuation, Pension Transition and                              2- Personnel Office                         3- Contributor
                                       Client Services Sector                                                 Bureau du personnel                         Cotisant
                                       Secteur des Pensions de retraite, Regroupement des
                                       pensions et Services à la clientèle
                                                                                                                                                                                  Page 1

                                                                                                        FORMULAIRE POUR OPTION DE RACHAT DE
  ELECTION FORM FOR TRANSFER VALUE SERVICE                                                              SERVICE VISÉ PAR UNE VALEUR DE TRANSFERT
Provision of the information requested on this document is voluntary. This                         La communication des renseignements demandés dans ce document est facultative.
information is being collected for the purpose of the administration of the Public                 Ces renseignements sont recueillis aux fins de l'administration de la Loi sur la pension
Service Superannuation Act (PSSA) and is essential to making a decision directly                   de la fonction publique (LPFP) et sont essentiels pour prendre une décision qui vous
affecting you. This information will be stored in Personal Information Bank number                 concerne directement. Ces renseignements seront versés au fichier de
PWGSC PCE 702. It is protected from disclosure to unauthorized persons or                          renseignements personnels numéro TPSGC PCE 702. Ils sont protégés contre toute
agencies pursuant to the provisions of the Privacy Act. Under the Act you have the                 divulgation à des personnes ou à des organismes non autorisés, conformément aux
right to request access to your personal information, held by a federal government                 dispositions de la Loi sur la protection des renseignements personnels. Aux termes de
institution, and to request corrections should you believe the information contains                ladite loi, vous avez le droit de vous faire communiquer les renseignements
errors or omissions.                                                                               personnels vous concernant qui sont conservés par une institution du gouvernement
                                                                                                   fédéral et de demander des corrections ou des modifications si, selon vous, ils sont
                                                                                                   erronés ou incomplets.

                      Instructions to the Contributor                                                                 Directives à l'intention du cotisant
1. Completion of Form                                                                              1. Comment remplir le formulaire
    Care should be taken when completing this form since, under most                                   Il faut remplir le formulaire avec grand soin, car, dans la plupart des cas, l'option
    circumstances, an election is a binding, irrevocable agreement. Please                             exercée est considérée comme étant une entente exécutoire et irrévocable.
    ensure that the dates of the service which you enter are complete and                              Veuillez vous assurer que les dates des périodes de service inscrites soient
    accurate. If you have more than one transfer value option, then the most                           complètes et exactes. Si vous avez reçu plusieurs prestations de valeur de
    recent transfer value must be purchased in its entirety first.                                     transfert, vous devrez en premier racheter entièrement le service qui correspond à
                                                                                                       la plus récente prestation de valeur de transfert.

2. Forwarding of Form                                                                              2. Transmission du formulaire
    If you are a new contributor, you must make your election within one year from the                 Si vous êtes un nouveau cotisant, vous devez exercer votre option dans l’année
    date of issue of the "Notification of Contributory Status" (PWGSC-TPSGC 2018)                      qui suit la date d’émission de l’avis intitulé « Notification concernant le statut de
    that you have received.                                                                            cotisant » (PWGSC-TPSGC 2018) que vous avez reçu.

    If you are already a contributor prior to the effective date of the new transfer value             Si vous étiez cotisant avant la date d’entrée en vigueur des nouveaux règlements
    reinstatement regulations, the completed election form must be forwarded within                    concernant le rachat de service visé par une valeur de transfert, le présent
    one year of that date.                                                                             formulaire dûment rempli doit être envoyé au plus tard dans un délai d’un an à
                                                                                                       compter de ladite date d’entrée en vigueur.

    The completed election form must be forwarded within the appropriate time                          Le formulaire dûment rempli doit être envoyé, dans le délai d’un an qui s’applique à
    outlined above, to your personnel office or to the Superannuation, Pension Transition              votre cas, à votre bureau du personnel ou au Secteur des Pensions de retraite,
    and Client Services Sector at the following address:                                               Regroupement des pensions et Services à la clientèle, à l’adresse suivante :

    Superannuation, Pension Transition and                                                             Secteur des Pensions de retraite, Regroupement des
    Client Services Sector                                                                             pensions et Services à la clientèle
    P.O. Box 5010                                                                                      C.P. 5010
    Shediac, N.B.                                                                                      Shediac (N.-B.)
    E4P 9B4                                                                                            E4P 9B4

    Use of registered mail is recommended, however, you may also hand                                  Il est conseillé d’envoyer le formulaire par courrier recommandé. Toutefois, vous
    deliver it to your personnel office. If sent by registered mail, the receipt of registration       pouvez le remettre en main propre à votre bureau du personnel. Si vous l’envoyez
    should be kept for your records. The date on which this form is mailed must be                     par courrier recommandé, vous devriez conserver le reçu remis par la poste. La
    indicated in the space provided in Part “B”.                                                       date à laquelle le présent formulaire est posté doit être inscrite dans la case prévue
                                                                                                       à cet effet dans la partie « B ».


3. Validation of Election                                                                          3. Validation de l'option
    Medical                                                                                            Examen médical
    An election for reinstatement of transfer value service must be validated by a                     Pour valider l’option de rachat de service visé par une valeur de transfert, vous
    medical examination. You must undergo an examination within 90 days prior to or 6                  devez subir un examen médical dans les 90 jours qui précèdent la date d'exercice
    months after making the election. The required medical forms to be completed by                    de l'option ou dans les 6 mois qui suivent cette date. Les formulaires à remplir par
    your physician should be forwarded to the Regional Medical Services Office (Health                 votre médecin doivent être envoyés au bureau régional des services médicaux
    Canada) as indicated on the medical forms.                                                         (Santé Canada) comme indiqué sur les formulaires d'examen médical.


4. Payment Method                                                                                  4. Mode de paiement
    Only payments received within 90 days of the date the election is received by the                  Seuls les paiements reçus dans les 90 jours suivant la date à laquelle le ministre
    Minister will be accepted and used to calculate the pensionable service that can be                reçoit l’option seront acceptés et serviront à calculer la période de service
    reinstated.                                                                                        ouvrant droit à pension rachetée par le cotisant.

5. Past Service Pension Adjustment (PSPA)                                                          5. Facteur d'équivalence pour services passés (FESP)
    A PSPA must be reported to the Canada Revenue Agency (CRA) for all elections in                    Il faut indiquer à l'Agence du revenu du Canada (ARC) le facteur d'équivalence à
    respect of post-1989 service. Where CRA does not approve the PSPA, the election                    l'égard de toute option exercée se rapportant à une période de service postérieure à
    will be declared invalid.                                                                          1989. Si l'ARC n'approuve pas le FESP, l’option sera déclarée invalide.


6. Inquiries                                                                                       6. Renseignements
    If you require further information on the completion of the "Election Form for                     Pour toute demande d'information supplémentaire pour remplir le « Formulaire pour
    Transfer Value Service", please contact the Superannuation, Pension Transition                     option de rachat de service visé par une valeur de transfert », veuillez vous adresser
    and Client Services Sector, at 1 800 883-1411.                                                     au Secteur des Pensions de retraite, Regroupement des pensions et Services à la
                                                                                                       clientèle, au 1 800 883-1411.


         Instructions to the Personnel Office and to the                                             Directives à l'intention du bureau du personnel et du Secteur
     Superannuation, Pension Transition and Client Services                                            des Pensions de retraite, Regroupement des pensions et
                              Sector                                                                                       Services à la clientèle
    The date of receipt, registration number and initials must be recorded in the space                La date de réception, le numéro d'inscription et les initiales doivent être inscrits
    provided in Part "C".                                                                              dans les cases prévues à cette fin dans la partie « C ».

    Copy 1 of this form, with the employee's original signature, must be forwarded to                  L’exemplaire 1 du formulaire (l’original signé par l'employé) doit être envoyé au
    the Superannuation, Pension Transition and Client Services Sector, immediately                     Secteur des Pensions de retraite, Regroupement des pensions et Services à la
    upon receipt by the personnel office.                                                              clientèle, dès sa réception par le bureau du personnel.



PWGSC-TPSGC 2005 (04/2005)
             Public Works and Government                    Travaux publics et Services                                                                                   Protected "B" when completed
             Services Canada                                gouvernementaux Canada                                                                                         Protégé « B » lorsque rempli
             Superannuation, Pension                        Secteur des Pensions de retraite,
             Transition and Client Services                 Regroupement des Pensions et                                                             Clear Data / Effacer les données
             Sector                                         Services à la clientèle


                                   PENSIONABLE EMPLOYMENT QUESTIONNAIRE
                           QUESTIONNAIRE RELATIF À UN EMPLOI OUVRANT DROIT À PENSION

Provision of the information requested on this document is voluntary. This information is being            La communication des renseignements demandés dans ce document est facultative. Ces
collected for the purpose of the Public Service Superannuation Act (PSSA) and is essential to              renseignements sont recueillis aux fins de la Loi sur la pension de la fonction publique (LPFP) et sont
making a decision directly affecting you. Refusal to respond may prevent you from electing to count        essentiels pour prendre une décision qui vous concerne directement. Un refus de répondre pourrait
under the PSSA, a period of prior pensionable service with an outside employer. This information           vous priver d'exercer une option de rachat en vertu de la LPFP pour une période de service antérieur
will be stored in Personal Information Bank number PWGSC PCE 702. It is protected from                     ouvrant droit à pension avec un employeur à l'extérieur de la fonction publique. Ces renseignements
disclosure to unauthorized persons/agencies pursuant to the provisions of the Privacy Act. Under           seront versés au fichier de renseignements personnels numéro TPSGC PCE 702. Ils sont protégés
the Act you have the right to request access to your personal information held by a federal                contre toute divulgation à des personnes ou à des organismes non autorisés, conformément aux
government institution and to request corrections should you believe the information contains errors       dispositions de la Loi sur la protection des renseignements personnels. Aux termes de ladite loi, vous
or omissions. Personal information that you provide about another individual may be accessible to          avez le droit de vous faire communiquer les renseignements personnels vous concernant et conservés
that person under the Privacy Act.                                                                         par une institution du gouvernement fédéral et de demander des corrections si, selon vous, ils sont
                                                                                                           erronés ou incomplets. Les renseignements personnels que vous fournissez au sujet d'une autre
                                                                                                           personne peuvent être communiqués à celle-ci en vertu de la Loi sur la protection des renseignements
                                                                                                           personnels.

To: (name and address of employer outside the public service)                                              Return to - Retourner à :
Au : (nom et adresse de l'employeur à l'extérieur de la fonction publique)                                  Superannuation, Pension                             Secteur des Pensions de retraite,
                                                                                                            Transition and Client Services                      Regroupement des Pensions et
                                                                                                            Sector                                              Services à la clientèle
                                                                                                            P.O. Box 5010                                       C.P. 5010
                                                                                                            Shediac, NB                                         Shediac (N-B)
                                                                                                            E4P 9B4                                             E4P 9B4
Under the Public Service Superannuation Act, an employee may elect to                                      Selon la Loi sur la pension de la fonction publique, un employé peut choisir
count as pensionable service any qualifying period of employment with your                                 de compter comme service ouvrant droit à pension toute période d'emploi
organization; which could have been counted, upon becoming a member of                                     avec votre organisme qu'il aurait pu compter en devenant participant à votre
your pension plan.                                                                                         régime de pension.
Forward this form to your pension plan administrator if pension records are                                Remettre ce formulaire à l'administrateur du régime de pension si votre
not held in your office.                                                                                   bureau ne conserve pas les dossiers de pension.
1. Release Authorization of the Employee - Formulaire d'autorisation de l'employé
Name of Employee (include maiden name, if applicable)                                                      Period of Employment - Période d'emploi
Nom de l'employé (inclure le nom de jeune fille, s'il y a lieu)
                                                                                                                                Y-A     M     D-J                                  Y-A     M      D-J
                                                                                                             From                                                    To
                                                                                                               Du                                                    Au

 Employment Location - Lieu d'emploi                       Date of Birth - Date de naissance Reference Number                                                     Superannuation Number
                                                                       Y-A   M    D-J        Numéro de référence                                                  Numéro de pension de retraite
                                                                                                                           _________                                              _________
I hereby authorize for release to the Superannuation, Pension Transition                                   Je vous autorise par la présente à divulguer au Secteur des Pensions de
and Client Services Sector of Public Works and Government Services                                         retraite, Regroupement des pensions et Services à la clientèle de Travaux
Canada, any information requested by this form regarding the time,                                         publics et Services gouvernementaux Canada, les renseignements demandés
duration and pensionable status of my former employment with your                                          dans le présent formulaire concernant la date et la durée de mon emploi
organization. I also authorize the release of information held by the pension                              antérieur avec votre organisme et le fait qu'il ouvrait droit à pension ou non.
plan administrator.                                                                                        J'autorise aussi la divulgation des renseignements conservés par
                                                                                                           l'administrateur du régime de pension.
Signature of Employee - Signature de l'employé                         Date    Y-A     M     D-J           Telephone No. (residence)                             Telephone No. (office)
                                                                                                           N° de téléphone (domicile)                            N° de téléphone (bureau)
                                                                                                                        (___) ___-____                                  (___) ___-____ [____]
2. Particulars of Employment - Détails relatifs à l'emploi

                                             Y-A     M     D-J                                                                                                      Y-A     M      D-J
Date of Commencement                                                                                           Date of Termination
Date du début de l'emploi                                                                                      Date de la cessation d'emploi


1. Was this person subject to your pension fund or plan during his employment?
   Cette personne était-elle assujettie à votre caisse de retraite ou à votre régime de pension pendant sa période d'emploi?
                 Yes               No        If no, go to Section 5.
                 Oui               Non       Si non, passez à la section 5.


2. (a) The plan was:
       Le régime était :
                  A Defined Benefit Plan                                             A Money Purchase Plan
                  Un régime à prestations déterminées                                Un régime à cotisations déterminées
                  Other (specify)
                  Autre (préciser)

     (b) In addition, please advise if your pension plan is registered under the Canadian Income Tax Act.
         De plus, veuillez nous aviser si votre régime de pension est reconnu en vertu de la Loi de l'impôt sur le revenu du Canada.
                 Yes               No
                 Oui               Non

           If yes, please indicate the registration date and number.
           Si oui, veuillez préciser la date et le numéro d'inscription.
                                                   Y-A    M      D-J
           Registration Date                                                                                    Registration Number
           Date d'inscription                                                                                   Numéro d'inscription


3. State the official title of your pension plan.
   Donner le titre officiel de votre régime de pension.

4. Insert the exact dates of employment and pensionable service credit                                     Veuillez insérer les dates exactes de la période d'emploi et du service
   or benefit purposes under your pension plan in effect at the date this                                  ouvrant droit à pension ou à des prestations en vertu de votre régime de
   employee terminated his employment. Include any qualifying periods                                      pension de retraite qui était en vigueur à la date de cessation d'emploi de
   purchased or automatically credited (i.e. without cost to the employee)                                 cet employé. Inclure toute période d'admissibilité qui est achetée ou
   on becoming a member of your pension plan.                                                              automatiquement portée au crédit de l'employé (c.-à-d. sans frais pour lui)
                                                                                                           quand il devient participant à votre régime.

                                Y-A     M      D-J                                             Y-A     M      D-J                             Years - Années Months - Mois                     Days - Jours
           From                                                               To
             Du                                                               Au


PWGSC-TPSGC 2069 (08/2006)                                                                                                                           (Continued on next page - Suite à la page suivante)
3. Particulars of Pension Benefits on Separation - Détails sur les prestations de pension au moment de la cessation
A. Upon separation, what type of benefit was the employee paid under your pension plan?
   Au moment de la cessation d'emploi, quel genre de prestation l'employé a-t-il touché au titre de votre régime de pension?

     If you check (a), (b) or (c), please complete section "C" and "D" below.
     Si vous avez coché (a), (b) ou (c), veuillez remplir les sections « C » et « D » ci-dessous.


                 Return of Contributions                        Commuted Value                                   Other Benefit (specify type)
     (a)         Remboursement de                  (b)                                              (c)
                                                                Valeur de rachat                                 Autre prestation (précisez le genre)
                 cotisations
                                                          Y-A     M      D-J
     Date payment issued for (a), (b) or (c)
     Date du paiement pour (a), (b) ou (c)

                                                                                      Y-A       M   D-J
     (d)
                 Annual Pension                     Effective Date
                 Pension annuelle                   À compter du

     (e)
                 Government Annuities               Contract No.                                                     Underwritten by Government Annuities Contract Branch
                 Rentes sur l'État                  N° du contrat                                                    Assuré par la Direction des rentes sur l'État


If any portion of the benefit remains to the employee's credit, please complete section B below.
Si une partie de la prestation est toujours au crédit de l'employé, veuillez remplir la section B ci-après.

B. Was the employee entitled to more than one type of benefit?                            Yes              No         Indicate the period of service related to each benefit.
   L'employé avait-il droit à plus d'un genre de prestations?                             Oui              Non        Indiquer la période de service correspondant à chaque type
                                                                                                                      de prestations.

                                                                Subject to Lock-in                  Transferable                   Period of Service - Période de service
       Benefit Types - Genre de prestations                 Assujettie à la disposition             Transférable                      From - Du                    To - Au
                                                                   de blocage                                                   Y-A      M      D-J        Y-A      M      D-J
                                                                   Yes              No              Yes            No
1.                                                                 Oui              Non             Oui            Non
                                                                      Yes           No              Yes            No
2.                                                                    Oui           Non             Oui            Non
                                                                      Yes           No              Yes            No
3.                                                                    Oui           Non             Oui            Non


 C. If the benefit was a type described in 3A(a), (b) or (c), was it transferred to:
    Si la prestation était d'un genre décrit en 3A(a), (b) ou (c), a-t-elle été transférée à un :
              RRSP
              REER
Registered Pension Plan (RPP):                           Defined Benefit                                          Money Purchase
Régime de pension agréé (RPA) :                          Prestations déterminées                                  Cotisations déterminées
              Other (specify)
              Autre (préciser)

What amount of the total sum transferred, was in respect of post 1989 service?
Quelle partie du montant total transféré correspondait à une période de service rendu après 1989 ?


D. State the pensionable earnings and pension adjustment amounts for post 1989 service.
   Indiquer les gains ouvrant droit à pension et les facteurs d'équivalence pour le service rendu après 1989.
        Year                Pensionable Earnings                      PA / PSPA                            Year               Pensionable Earnings                PA / PSPA
       Année             Gains ouvrant droit à pension                FE / FESP                           Année            Gains ouvrant droit à pension          FE / FESP




4. Plan Information - Renseignements sur le régime
Please note that this section requests general information about your pension plan. It does not specifically relate to the circumstances of this former
employee, except as to the provisions of the plan in effect at the time his participation under your plan ceased.
Veuillez noter que vous devez fournir des renseignements sur votre régime de pension dans la présente section. Ces questions ne concernent en rien
l'employé, sauf en ce qui a trait aux dispositions du régime en vigueur au moment où l'employé a cessé d'y participer.

When the employee ceased to be a participant, did the pension plan in effect provide for an annuity type benefit that:
Lorsque l'employé a cessé de cotiser, le régime de pension en vigueur prévoyait-il une prestation de pension :

is provided in whole or in part as a result of contributions from                      Yes                No        qui provient entièrement ou en partie des cotisations payées
the employer?                                                                          Oui                Non       par l'employeur ?

is related in amount to the period of service countable by the                         Yes                No        dont le montant correspond à la période de service que le
person to whom it is payable?                                                          Oui                Non       bénéficiaire peut faire compter ?

is payable in installments during the lifetime of the recipient                        Yes                No        qui est payable par versement pour la durée de vie du
and thereafter if the pension plan so provides?                                        Oui                Non       bénéficiaire et après son décès si le régime de pension le
                                                                                                                    prévoit ainsi ?

5. Certification - Attestation
The information provided in this questionnaire is certified to be correct.
Les renseignements fournis dans le présent questionnaire sont certifiés conformes.



                                                                                                                         (___) ___-____ [____]
            Authorized Signing Officer                                         Title - Titre                                 Telephone No.                         Date
           Signature de l'agent autorisé                                                                                     N° de téléphone               (Y-A     M D-J)

PWGSC-TPSGC 2069 (08/2006)
             Public Works and Government            Travaux publics et Services             Clear Data - Effacer l'information                      Protected "B" when completed
             Services Canada                        gouvernementaux Canada                                                                           Protégé « B » lorsque rempli
            Superannuation, Pension                 Secteur des Pensions de retraite,
            Transition and Client Services          Regroupement des pensions et Services
            Sector                                  à la clientèle

            Public Service                          Administration de la Loi
            Superannuation Act                      sur la pension de la
            Administration                          fonction publique

ELECTION TO SURRENDER BENEFITS                                                                 RENONCIATION AUX PRESTATIONS
Payable under the Canadian Forces Superannuation Act (CFSA) or the                             Payables aux termes de la Loi sur la pension de retraite des Forces
Royal Canadian Mounted Police Superannuation Act (RCMPSA).                                     canadiennes (LPRFC) ou de la Loi sur la pension de retraite de la
                                                                                               Gendarmerie royale du Canada (LPRGRC).
Note: To be completed by recipients of monthly pensions or by persons                          Remarque : À être rempli par les bénéficiaires de pensions mensuelles ou
who have not received or are not entitled to receive a return of CFSA or                       par des personnes qui n'ont pas reçu le remboursement de leurs cotisations
RCMPSA contributions.                                                                          à la LPRFC ou à la LPRGRC ou qui n'y sont pas admissibles.
Provision of the information requested on this document is voluntary. This                     La communication des renseignements demandés dans ce document est facultative.
information is being collected for the purpose of the administration of the Public             Ces renseignements sont recueillis aux fins de l'administration de la Loi sur la pension
Service Superannuation Act (PSSA) and is essential to making a decision directly               de la fonction publique (LPFP) et sont essentiels pour rendre une décision qui vous
affecting you. Refusal to respond may result in you not surrendering your benefits             touche directement. Un refus de répondre pourrait vous empêcher de renoncer à votre
under the Canadian Forces Superannuation Act (CFSA) or the Royal Canadian                      prestation en vertu de la Loi sur la pension de retraite des Forces canadiennes
Mounted Police Superannuation Act (RCMPSA). This information will be stored in                 (LPRFC) ou de la Loi sur la pension de retraite de la Gendarmerie royale du Canada
Personal Information Bank number PWGSC PCE 702. It is protected from                           (LPRGRC). Ces renseignements seront versés au fichier de renseignements
disclosure to unauthorized persons or agencies pursuant to the provisions of the               personnels numéro TPSGC PCE 702. Ils sont protégés contre toute divulgation à des
Privacy Act. Under the Act you have the right to request access to your personal               personnes ou à des organismes non autorisés, conformément aux dispositions de la
information, held by a federal government institution, and to request corrections              Loi sur la protection des renseignements personnels. Aux termes de ladite loi, vous
should you believe the information contains errors or omissions. Personal                      avez le droit de vous faire communiquer les renseignements personnels vous
information that you provide about another individual may be accessible to that                concernant et qui sont conservés par une institution du gouvernement fédéral et de
person under the Privacy Act.                                                                  demander des corrections si, selon vous, ils sont erronés ou incomplets. Les
                                                                                               renseignements personnels que vous fournissez au sujet d'une autre personne
                                                                                               peuvent être communiqués à celle-ci en vertu de la Loi sur la protection des
                                                                                               renseignements personnels.
       TO BE COMPLETED BY THE PERSONNEL OFFICE (when completed, forward all copies to the contributor)
A-
       À ÊTRE REMPLI PAR LE BUREAU DU PERSONNEL (lorsque rempli, faire parvenir tous les exemplaires au cotisant)
Family Name - Nom de famille                                   Given Name(s) - Prénoms                            CF or RCMP Superannuation No.
                                                                                                                  N° de pension de retraite des FC ou de la GRC


Complete Home Address - Adresse complète du domicile                                                              PRI - CIDP                          Superannuation No.
                                                                                                                                                      N° de pension de retraite


Department - Ministère                                    Branch or Service - Direction ou Service                Pay Office         Dept. - Min.     PL No.          Employee No.
                                                                                                                  Bureau de paye                      N° LP           N° de l'employé


Address of Personnel Office - Adresse du bureau du personnel                                                                                          Tel. No. - Nº de tél.



Name and Address of Pay Office - Nom et adresse du bureau de paye




       TO BE COMPLETED BY THE CONTRIBUTOR (when completed, retain copy 4 and forward the remaining copies to:)
B-
       À ÊTRE REMPLI PAR LE COTISANT (lorsque rempli, conserver l'exemplaire 4 et envoyer les autres exemplaires à la : )
Pension Services Directorate             Direction des services de pension de retraite         Pension Services Directorate            Direction des services de pension de retraite
Public Works and Government              Travaux publics et Services                           Public Works and Government             Travaux publics et Services
Services Canada                          gouvernementaux Canada                                Services Canada                         gouvernementaux Canada
                            Ottawa, Canada                                            OR                                     Ottawa, Canada
                                K1A 0S5                                               OU                                         K1A 0S5
Attention: Specialized Services           À l'attention de la Division des services             Attention: Specialized Services        À l'attention de la Division des services
Division - Canadian Forces                spécialisés des Forces canadiennes                    Division - RCMP                        spécialisés de la GRC

1. I hereby elect, pursuant to Subsection 39(6) of the Public Service                          1. Par la présente, je choisis conformément au paragraphe 39(6) de la
   Superannuation Act, to surrender the annuity, annual allowance or                              Loi sur la pension de la fonction publique de renoncer à toute rente,
   pension to which I am entitled under the                                                       allocation annuelle ou pension auxquelles j'ai droit aux termes de la
                                          Canadian Forces Superannuation Act                       Loi sur la pension de retraite des Forces canadiennes
                                     Defence Services Pension Continuation Act                     Loi sur la continuation de la pension des services de défense
                          Royal Canadian Mounted Police Superannuation Act                         Loi sur la pension de retraite de la Gendarmerie Royale du Canada
                      Royal Canadian Mounted Police Pension Continuation Act                       Loi sur la continuation des pensions de la Gendarmerie Royale du Canada


2. I further elect to pay for the period of service that was countable for                     2. Je choisis en outre de payer pour la période de service qui comptait
   pension purposes under the above Act(s).                                                       comme ouvrant droit à pension conformément aux lois précitées.
     In a lump-sum, by transfer to the Public Service Pension fund of the                          Par somme globale, par le virement à la Caisse de retraite de la fonction
     contributions to my credit under the applicable Act (which transfer I hereby                  publique des cotisations à mon crédit conformément à la loi pertinente (virement
     authorize).                                                                                   que j'autorise par la présente).

     In a lump-sum, by cheque or money order (enclosed), payable to the                            Par somme globale versée par chèque ou par mandat (ci-joint) à l'ordre du
     Receiver General for Canada, in the sum of                               .                    receveur général du Canada, au montant de                                 .

     In monthly installments to be deducted from my salary in accordance with                      Par versements mensuels à être prélevés de mon traitement conformément aux
     the provisions of the Public Service Superannuation Act.                                      dispositions de la Loi sur la pension de la fonction publique.


3. I further elect to pay the amount required (if applicable) by                               3. Je choisis en outre de payer le montant demandé au paragraphe
   Subsection 39(7) of the Public Service Superannuation Act as                                   39(7) de la Loi sur la pension de la fonction publique, comme
   pension repayment, in the following manner:                                                    remboursement de pension, s'il y a lieu, de la façon suivante :

     by lump-sum of                         (enclosed is a cheque or money                         par somme globale de                             (ci-joint un chèque ou mandat à
     order payable to the Receiver General for Canada), or                                         l'ordre du receveur général du Canada), ou

     by monthly installments over            years to be deducted from my                          par versements mensuels durant une période de            ans à être prélevés de
     salary in accordance with the provisions of the Public Service                                mon traitement conformément aux dispositions de la Loi sur la pension de la
     Superannuation Act.                                                                           fonction publique.

Signed at - Signé à                                                                            Witness - Témoin


                                                                                                                                       Signature
                                                                                               Contributor - Cotisant
This                       day of                      in the year
Ce                         jour de                     de l'année
                                                                                                                                       Signature

PWGSC-TPSGC 2092 (06/2004)
                                Transition and Client Services Sector
 1 - Superannuation, Pension retraite, Regroupement des pensions
     Secteur des Pensions de                                                         2-   Employing Department
                                                                                          Ministère employeur           3-   CF or RCMP Pensions Section
                                                                                                                             Section des pensions des FC           4-   Contributor
                                                                                                                                                                        Cotisant
     et Services à la clientèle                                                                                              ou de la GRC
                                                                   DIRECT TRANSFER UNDER SUBSECTION 146.3(14.1) OR
                                                                   PARAGRAPH 146(16)(a) OR 146.3(2)(e)
You can use this form to record a direct transfer. Please print, and check the boxes that apply to you. See the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

Area I – Annuitant
 Last name                                                           First name and initials                                                Social insurance number


 Address                                                                                                                                    Telephone



 Part A – Transfer from an RRSP or a RRIF
                                                                                               Individual plan
        I am the annuitant under the registered retirement savings plan (RRSP).                number, and name

                                                                                               Individual fund
        I am the annuitant under the registered retirement income fund (RRIF).                 number, and name

 Name of RRSP issuer or RRIF carrier                                                       Address



 Part B – Description of amount to be transferred

        Please transfer     all of the property,   the lump sum of $                     , or                                         payments of $                            ,
        which represents all or part of the property of my unmatured RRSP identified in Part A,                   in cash or   in kind.

        Except for enough property to pay me the minimum amount this year, please transfer all        of the property or   the lump sum
        of $                        , which represents part of the property of my RRIF identified in Part A,    in cash or   in kind.

 Part C – Identifying the RRSP, RRIF, or RPP the funds are being transferred to
                                                                                               Individual plan
        Please transfer the above-mentioned RRSP property to my RRSP.                          number, and name

                                                                                               Individual fund
        Please transfer the above-mentioned RRSP or RRIF property to my RRIF.                  number, and name

        Please ensure that the transfer of the above-mentioned RRSP or RRIF                    CRA registration
        property is credited to my account as a member of this registered pension              number, and name
        plan (RPP).
 Name of RRSP issuer, RRIF carrier, or RPP administrator                                   Address


 Date                                     Annuitant's signature

                                                                                                                                     or            See letter attached


Area II – Transferee
 1. We agree to the above request for a direct transfer of property. When we receive the property, we will credit it to the annuitant or member under the plan or
    fund identified in Part C of Area I. If the plan or fund is an RRSP or a RRIF that conforms to a specimen plan or fund, it will conform with the specimen
    identified as:
                                                                         We will check the plan or fund identification in Part C of Area I, and add or correct
                                                                         information as necessary.
                  Specimen plan or fund number, and name
 2. The plan or fund is registered under the Income Tax Act or, if the plan or fund is not registered, we will apply for such registration according to Information
    Circulars 72-22 and 78-18.
 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area III – Transferor (Do not issue a T4RSP or T4RIF slip for the amount transferred.)

 1. We have transferred $                          from the RRSP or RRIF identified in Part A of Area I to the transferee named in Part C of Area I. If RRIF
    property is transferred to another RRIF or an RPP, we have paid or will pay the annuitant the minimum amount for the year.
 2. Is the transfer from a qualifying RRIF as defined on the back of this form?                                              Yes      No        Does not apply
 3. Has the annuitant's spouse or common-law partner ever contributed amounts to the RRSP?                                                Yes        No       Does not apply
 4. Does the RRIF include amounts transferred from an RRSP to which the annuitant's spouse or common-law                                  Yes        No       Does not apply
    partner has contributed?
 Spouse or common-law partner               Last name                            First name                                                 Social insurance number



 5. The transferee has to continue to administer $                     as a locked-in amount, as required by the Pension Benefits Standards Act or
    a provincial act (specify the act)                   .
    For some provinces, you can transfer pension funds and locked-in RRSP funds to a locked-in RRIF.                                      Does not apply

 I certify that the information given on this form is correct and complete.
 Transferor's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area IV – Receipt by transferee (Do not issue an official receipt for the amount transferred.)

 We have received $                                  for transfer and administration according to Area I and, if applicable, Area III.

 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



                                        (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
T2033 E (07)
                                                                  Copy 1 – For the transferor
                                                                  DIRECT TRANSFER UNDER SUBSECTION 146.3(14.1) OR
                                                                  PARAGRAPH 146(16)(a) OR 146.3(2)(e)
You can use this form to record a direct transfer. Please print, and check the boxes that apply to you. See the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

Area I – Annuitant
 Last name                                                           First name and initials                                                Social insurance number


 Address                                                                                                                                    Telephone



 Part A – Transfer from an RRSP or a RRIF
                                                                                               Individual plan
        I am the annuitant under the registered retirement savings plan (RRSP).                number, and name

                                                                                               Individual fund
        I am the annuitant under the registered retirement income fund (RRIF).                 number, and name

 Name of RRSP issuer or RRIF carrier                                                       Address



 Part B – Description of amount to be transferred

        Please transfer     all of the property,   the lump sum of $                     , or                                         payments of $                            ,
        which represents all or part of the property of my unmatured RRSP identified in Part A,                   in cash or   in kind.

        Except for enough property to pay me the minimum amount this year, please transfer all        of the property or   the lump sum
        of $                        , which represents part of the property of my RRIF identified in Part A,    in cash or   in kind.

 Part C – Identifying the RRSP, RRIF, or RPP the funds are being transferred to
                                                                                               Individual plan
        Please transfer the above-mentioned RRSP property to my RRSP.                          number, and name

                                                                                               Individual fund
        Please transfer the above-mentioned RRSP or RRIF property to my RRIF.                  number, and name

        Please ensure that the transfer of the above-mentioned RRSP or RRIF                    CRA registration
        property is credited to my account as a member of this registered pension              number, and name
        plan (RPP).
 Name of RRSP issuer, RRIF carrier, or RPP administrator                                   Address


 Date                                     Annuitant's signature

                                                                                                                                     or            See letter attached


Area II – Transferee
 1. We agree to the above request for a direct transfer of property. When we receive the property, we will credit it to the annuitant or member under the plan or
    fund identified in Part C of Area I. If the plan or fund is an RRSP or a RRIF that conforms to a specimen plan or fund, it will conform with the specimen
    identified as:
                                                                         We will check the plan or fund identification in Part C of Area I, and add or correct
                                                                         information as necessary.
                  Specimen plan or fund number, and name
 2. The plan or fund is registered under the Income Tax Act or, if the plan or fund is not registered, we will apply for such registration according to Information
    Circulars 72-22 and 78-18.
 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area III – Transferor (Do not issue a T4RSP or T4RIF slip for the amount transferred.)

 1. We have transferred $                          from the RRSP or RRIF identified in Part A of Area I to the transferee named in Part C of Area I. If RRIF
    property is transferred to another RRIF or an RPP, we have paid or will pay the annuitant the minimum amount for the year.
 2. Is the transfer from a qualifying RRIF as defined on the back of this form?                                              Yes      No        Does not apply
 3. Has the annuitant's spouse or common-law partner ever contributed amounts to the RRSP?                                                Yes        No       Does not apply
 4. Does the RRIF include amounts transferred from an RRSP to which the annuitant's spouse or common-law                                  Yes        No       Does not apply
    partner has contributed?
 Spouse or common-law partner               Last name                            First name                                                 Social insurance number



 5. The transferee has to continue to administer $                     as a locked-in amount, as required by the Pension Benefits Standards Act or
    a provincial act (specify the act)                   .
    For some provinces, you can transfer pension funds and locked-in RRSP funds to a locked-in RRIF.                                      Does not apply

 I certify that the information given on this form is correct and complete.
 Transferor's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area IV – Receipt by transferee (Do not issue an official receipt for the amount transferred.)

 We have received $                                  for transfer and administration according to Area I and, if applicable, Area III.

 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office


                                        (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
T2033 E (07)                                            Copy 2 – For the annuitant (All areas completed)
                                                        Do not attach this copy to your income tax return.
                                                                   DIRECT TRANSFER UNDER SUBSECTION 146.3(14.1) OR
                                                                   PARAGRAPH 146(16)(a) OR 146.3(2)(e)
You can use this form to record a direct transfer. Please print, and check the boxes that apply to you. See the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

Area I – Annuitant
 Last name                                                           First name and initials                                                Social insurance number


 Address                                                                                                                                    Telephone



 Part A – Transfer from an RRSP or a RRIF
                                                                                               Individual plan
        I am the annuitant under the registered retirement savings plan (RRSP).                number, and name

                                                                                               Individual fund
        I am the annuitant under the registered retirement income fund (RRIF).                 number, and name

 Name of RRSP issuer or RRIF carrier                                                       Address



 Part B – Description of amount to be transferred

        Please transfer     all of the property,   the lump sum of $                     , or                                         payments of $                            ,
        which represents all or part of the property of my unmatured RRSP identified in Part A,                   in cash or   in kind.

        Except for enough property to pay me the minimum amount this year, please transfer all        of the property or   the lump sum
        of $                        , which represents part of the property of my RRIF identified in Part A,    in cash or   in kind.

 Part C – Identifying the RRSP, RRIF, or RPP the funds are being transferred to
                                                                                               Individual plan
        Please transfer the above-mentioned RRSP property to my RRSP.                          number, and name

                                                                                               Individual fund
        Please transfer the above-mentioned RRSP or RRIF property to my RRIF.                  number, and name

        Please ensure that the transfer of the above-mentioned RRSP or RRIF                    CRA registration
        property is credited to my account as a member of this registered pension              number, and name
        plan (RPP).
 Name of RRSP issuer, RRIF carrier, or RPP administrator                                   Address


 Date                                     Annuitant's signature

                                                                                                                                     or            See letter attached


Area II – Transferee
 1. We agree to the above request for a direct transfer of property. When we receive the property, we will credit it to the annuitant or member under the plan or
    fund identified in Part C of Area I. If the plan or fund is an RRSP or a RRIF that conforms to a specimen plan or fund, it will conform with the specimen
    identified as:
                                                                         We will check the plan or fund identification in Part C of Area I, and add or correct
                                                                         information as necessary.
                  Specimen plan or fund number, and name
 2. The plan or fund is registered under the Income Tax Act or, if the plan or fund is not registered, we will apply for such registration according to Information
    Circulars 72-22 and 78-18.
 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area III – Transferor (Do not issue a T4RSP or T4RIF slip for the amount transferred.)

 1. We have transferred $                          from the RRSP or RRIF identified in Part A of Area I to the transferee named in Part C of Area I. If RRIF
    property is transferred to another RRIF or an RPP, we have paid or will pay the annuitant the minimum amount for the year.
 2. Is the transfer from a qualifying RRIF as defined on the back of this form?                                              Yes      No        Does not apply
 3. Has the annuitant's spouse or common-law partner ever contributed amounts to the RRSP?                                                Yes        No       Does not apply
 4. Does the RRIF include amounts transferred from an RRSP to which the annuitant's spouse or common-law                                  Yes        No       Does not apply
    partner has contributed?
 Spouse or common-law partner               Last name                            First name                                                 Social insurance number



 5. The transferee has to continue to administer $                     as a locked-in amount, as required by the Pension Benefits Standards Act or
    a provincial act (specify the act)                   .
    For some provinces, you can transfer pension funds and locked-in RRSP funds to a locked-in RRIF.                                      Does not apply

 I certify that the information given on this form is correct and complete.
 Transferor's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area IV – Receipt by transferee (Do not issue an official receipt for the amount transferred.)

 We have received $                                  for transfer and administration according to Area I and, if applicable, Area III.

 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



                                        (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
T2033 E (07)
                                                 Copy 3 – For the transferee – All areas completed
                                                                   DIRECT TRANSFER UNDER SUBSECTION 146.3(14.1) OR
                                                                   PARAGRAPH 146(16)(a) OR 146.3(2)(e)
You can use this form to record a direct transfer. Please print, and check the boxes that apply to you. See the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

Area I – Annuitant
 Last name                                                           First name and initials                                                Social insurance number


 Address                                                                                                                                    Telephone



 Part A – Transfer from an RRSP or a RRIF
                                                                                               Individual plan
        I am the annuitant under the registered retirement savings plan (RRSP).                number, and name

                                                                                               Individual fund
        I am the annuitant under the registered retirement income fund (RRIF).                 number, and name

 Name of RRSP issuer or RRIF carrier                                                       Address



 Part B – Description of amount to be transferred

        Please transfer     all of the property,   the lump sum of $                     , or                                         payments of $                            ,
        which represents all or part of the property of my unmatured RRSP identified in Part A,                   in cash or   in kind.

        Except for enough property to pay me the minimum amount this year, please transfer all        of the property or   the lump sum
        of $                        , which represents part of the property of my RRIF identified in Part A,    in cash or   in kind.

 Part C – Identifying the RRSP, RRIF, or RPP the funds are being transferred to
                                                                                               Individual plan
        Please transfer the above-mentioned RRSP property to my RRSP.                          number, and name

                                                                                               Individual fund
        Please transfer the above-mentioned RRSP or RRIF property to my RRIF.                  number, and name

        Please ensure that the transfer of the above-mentioned RRSP or RRIF                    CRA registration
        property is credited to my account as a member of this registered pension              number, and name
        plan (RPP).
 Name of RRSP issuer, RRIF carrier, or RPP administrator                                   Address


 Date                                     Annuitant's signature

                                                                                                                                     or            See letter attached


Area II – Transferee
 1. We agree to the above request for a direct transfer of property. When we receive the property, we will credit it to the annuitant or member under the plan or
    fund identified in Part C of Area I. If the plan or fund is an RRSP or a RRIF that conforms to a specimen plan or fund, it will conform with the specimen
    identified as:
                                                                         We will check the plan or fund identification in Part C of Area I, and add or correct
                                                                         information as necessary.
                  Specimen plan or fund number, and name
 2. The plan or fund is registered under the Income Tax Act or, if the plan or fund is not registered, we will apply for such registration according to Information
    Circulars 72-22 and 78-18.
 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area III – Transferor (Do not issue a T4RSP or T4RIF slip for the amount transferred.)

 1. We have transferred $                          from the RRSP or RRIF identified in Part A of Area I to the transferee named in Part C of Area I. If RRIF
    property is transferred to another RRIF or an RPP, we have paid or will pay the annuitant the minimum amount for the year.
 2. Is the transfer from a qualifying RRIF as defined on the back of this form?                                              Yes      No        Does not apply
 3. Has the annuitant's spouse or common-law partner ever contributed amounts to the RRSP?                                                Yes        No       Does not apply
 4. Does the RRIF include amounts transferred from an RRSP to which the annuitant's spouse or common-law                                  Yes        No       Does not apply
    partner has contributed?
 Spouse or common-law partner               Last name                            First name                                                 Social insurance number



 5. The transferee has to continue to administer $                     as a locked-in amount, as required by the Pension Benefits Standards Act or
    a provincial act (specify the act)                   .
    For some provinces, you can transfer pension funds and locked-in RRSP funds to a locked-in RRIF.                                      Does not apply

 I certify that the information given on this form is correct and complete.
 Transferor's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office



Area IV – Receipt by transferee (Do not issue an official receipt for the amount transferred.)

 We have received $                                  for transfer and administration according to Area I and, if applicable, Area III.

 Transferee's name                                                                                                                          Date


 Authorized person's signature                                                             Position or office


                                        (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)

T2033 E (07)              Copy 4 – For the transferor, following receipt from the transferee of all copies –
                Area I completed by annuitant, Areas II and IV completed by transferee, and Area III by the transferor.
                                                                      Instructions

Who can use this form?

Carrier of a RRIF
You can use this form to record a direct transfer, under paragraph 146.3(2)(e), of all or part of the property of the fund to the carrier of another RRIF that has
the same annuitant. You can also use this form to record a direct transfer of all or part of an excess amount from a RRIF to another RRIF that has the same
annuitant. Since January 1, 2004, you can record a direct transfer under subsection 146.3(14.1) from an annuitant's RRIF to a money purchase provision of
an RPP for which the annuitant was a member before the transfer.

Issuer of an unmatured RRSP
You can use this form to record a direct transfer, under paragraph 146(16)(a), of all or part of the property of the plan to:
   the issuer of another RRSP having the same annuitant;
   the carrier of a RRIF having the same annuitant; or
   the administrator of a registered pension plan (RPP), for credit to the account of the annuitant as a member under that plan.

Note
You do not have to use this form. If, as the transferor, you provide the transferee with the information required to correctly complete the transfer (e.g., funds are
from a locked-in plan, funds are from a spousal or common-law partner plan, or funds are from a qualifying RRIF) you can use the method of documentation of
your choice.

Do not use this form for:
  a direct transfer of a full or partial commutation of an RRSP annuity to another RRSP or to a RRIF (use Form T2030, Direct Transfer Under
  Subparagraph 60(l)(v), instead);
  a direct transfer of an excess amount from a RRIF to an RRSP (use Form T2030 instead); or
  a direct transfer from an RRSP or RRIF because of the breakdown of a marriage or common-law relationship (use Form T2220, Transfer From an RRSP or
  a RRIF to Another RRSP or RRIF on Breakdown of Marriage or Common-Law Partnership, instead).

Who completes this form?

Area I
The annuitant asking for the transfer completes and signs Area I. Four copies of the form have to be given to the RRSP issuer, RRIF carrier, or RPP
administrator to which the property is to be transferred (the transferee). In place of a signature, the transferee who completes Area I for the annuitant can attach
a copy of a signed letter from the annuitant asking for the direct transfer.

Area II
The transferee completes and signs Area II. The transferee sends all copies to the RRSP issuer or RRIF carrier from which the property is to be transferred (the
transferor).

Area III
The transferor completes and signs Area III. The transferor keeps one copy, and sends the remaining three copies to the transferee, along with the property
being transferred.

Area IV
The transferee completes and signs Area IV of all copies. The transferee keeps one copy, returns one to the transferor, and gives the last one to the annuitant.

Reporting requirements

A direct transfer under subsection 146.3(14.1) or paragraphs 146(16)(a) or 146.3(2)(e) does not cause the amount transferred to become income of the
annuitant. Consequently, the transferor should not report the amount transferred on a T4RSP or T4RIF slip. Similarly, the transferee should not issue an official
receipt, since the annuitant cannot deduct the amount transferred.

Other requirements

A RRIF carrier that makes a direct transfer under subsection 146.3(14.1) or paragraph 146.3(2)(e) has to pay the annuitant the minimum amount for the year.

In all cases, the transferor should not withhold income tax from the amount directly transferred under subsection 146.3(14.1) or paragraphs 146(16)(a) or
146.3(2)(e).

                                                                           Definitions
Annuitant – The person who is entitled to receive payments from an RRSP or a RRIF.

Individual plan number or individual fund number – The individual account, contract, certificate, or other identifier number that the RRSP issuer or RRIF
                                                   carrier assigns.

Qualifying RRIF – A RRIF established before 1993, that has no property transferred or contributed to it after 1992, or any RRIF established after 1992,
                  that contains only property transferred from a qualifying RRIF.

RPP administrator – The person or organization that is responsible for administering the RPP.

RRIF carrier – A person described in subsection 146.3(1), with whom an annuitant has an arrangement that is a RRIF.

RRSP issuer – A person described in subsection 146(1), with whom an annuitant has a contract or arrangement that is an RRSP.




Printed in Canada
                                                           DIRECT TRANSFER OF A SINGLE AMOUNT UNDER SUBSECTION 147(19) OR SECTION 147.3
You can use this form to record a direct transfer. Tick the boxes that apply to you, and see the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

  Area I – Applicant

                                      Name                                                               Social insurance number                                         Telephone


                                                                                           Address
  If the transfer is from a deferred profit-sharing plan (DPSP), complete Parts A, C, and D below.
  If the transfer is from a registered pension plan (RPP), complete Parts B, C, and D below.
  Part A – Transfer from a DPSP
               I am an employee or former employee who is a beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of an employee or former
               employee who was the beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner of an employee or former employee who was the beneficiary of
               the DPSP requesting a transfer because of a breakdown of our marriage or common-law partnership.


           Canada Revenue Agency's DPSP registration number                                                                  Employer's name



                              Plan number                                                                                   Employer's address

  Part B – Transfer from an RPP
               I am a member of the RPP.

               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of a member of the RPP.

               I am the RPP member's current or former spouse or common-law partner requesting a transfer because of a breakdown of the marriage
               or common-law partnership.


            Canada Revenue Agency's RPP registration number                                                                  Employer's name


                              Plan number                                                                                   Employer's address
  Part C – Description of amount to be transferred
               Please transfer my whole entitlement under the plan identified in Part A or B.


               Please transfer $                                    , which is my partial entitlement under the plan identified in Part A or B.

  Part D – Identification of the RRSP, RRIF, RPP, or DPSP the funds are being transferred.
               Please transfer the RPP or DPSP single amount to my registered retirement savings plan (RRSP).

                         Individual plan number                                                             Name of plan and approved specimen plan number

               Please transfer the RPP or DPSP single amount to my registered retirement income fund (RRIF).

                         Individual fund number                                                             Name of fund and approved specimen fund number

               Please transfer the RPP or DPSP single amount to my account as a member of this RPP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number

               Please transfer the DPSP single amount to my account as a beneficiary under this DPSP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number



                                                                                     Transferee's address


                      Date                                                                Applicant's signature

 Area II – Transferor's certification
  1. The $                                   transferred is the applicant's           whole or              partial entitlement under:
          the DPSP identified in Part A of Area I, or   the RPP identified in Part B of Area I.
  2. We have transferred $                          according to:
               subsection 147(19) (a DPSP lump-sum transfer to an RPP, an RRSP, a RRIF, or another DPSP); or
               one of the following subsections: 147.3(1) to (8) (an RPP lump-sum transfer to an RRSP, a RRIF, or another RPP).
  3. A lock-in provision applies to $                      of the amount we transferred from the RPP identified in Part B of Area I, under the
     Pension Benefits Standards Act or a provincial pension benefits act (specify the act).                                     Does not apply
  4. We did not transfer $                           of the RPP single amount indicated in item 1 according to one of the following subsections:
      147.3(1) to (7). We will report this amount as the applicant's income on a T4A slip.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                     Transferor's name



               Date                                            Authorized person's signature                                                        Position or office
  Area III – Transferee's certification
   1. We have received $                         , and we have credited it to:
           the applicant's RRSP identified in Part D of Area I;
               the applicant's RRIF identified in Part D of Area I;
               the applicant's account as a member of the RPP identified in Part D of Area I; or
               the applicant's account as beneficiary under the DPSP identified in Part D of Area I.
  2. The plan to which the single amount has been transferred is registered under the Income Tax Act.
  3. We will administer the amount indicated in item 3 of Area II as a locked-in amount under the recipient fund or plan.
  4. We will issue a receipt for the amount indicated in item 4 of Area II.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                      Transferee's name


               Date                                             Authorized person's signature                                                        Position or office
T2151 E (07)                             (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
                                                                      Copy 1 – For the transferor (all areas completed)
                                                           DIRECT TRANSFER OF A SINGLE AMOUNT UNDER SUBSECTION 147(19) OR SECTION 147.3
You can use this form to record a direct transfer. Tick the boxes that apply to you, and see the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

  Area I – Applicant

                                      Name                                                               Social insurance number                                         Telephone


                                                                                           Address
  If the transfer is from a deferred profit-sharing plan (DPSP), complete Parts A, C, and D below.
  If the transfer is from a registered pension plan (RPP), complete Parts B, C, and D below.
  Part A – Transfer from a DPSP
               I am an employee or former employee who is a beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of an employee or former
               employee who was the beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner of an employee or former employee who was the beneficiary of
               the DPSP requesting a transfer because of a breakdown of our marriage or common-law partnership.


           Canada Revenue Agency's DPSP registration number                                                                  Employer's name



                              Plan number                                                                                   Employer's address

  Part B – Transfer from an RPP
               I am a member of the RPP.

               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of a member of the RPP.

               I am the RPP member's current or former spouse or common-law partner requesting a transfer because of a breakdown of the marriage
               or common-law partnership.


            Canada Revenue Agency's RPP registration number                                                                  Employer's name


                              Plan number                                                                                   Employer's address
  Part C – Description of amount to be transferred
               Please transfer my whole entitlement under the plan identified in Part A or B.


               Please transfer $                                    , which is my partial entitlement under the plan identified in Part A or B.

  Part D – Identification of the RRSP, RRIF, RPP, or DPSP the funds are being transferred.
               Please transfer the RPP or DPSP single amount to my registered retirement savings plan (RRSP).

                         Individual plan number                                                             Name of plan and approved specimen plan number

               Please transfer the RPP or DPSP single amount to my registered retirement income fund (RRIF).

                         Individual fund number                                                             Name of fund and approved specimen fund number

               Please transfer the RPP or DPSP single amount to my account as a member of this RPP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number

               Please transfer the DPSP single amount to my account as a beneficiary under this DPSP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number



                                                                                     Transferee's address


                      Date                                                                Applicant's signature

 Area II – Transferor's certification
  1. The $                                   transferred is the applicant's           whole or              partial entitlement under:
          the DPSP identified in Part A of Area I, or   the RPP identified in Part B of Area I.
  2. We have transferred $                          according to:
               subsection 147(19) (a DPSP lump-sum transfer to an RPP, an RRSP, a RRIF, or another DPSP); or
               one of the following subsections: 147.3(1) to (8) (an RPP lump-sum transfer to an RRSP, a RRIF, or another RPP).
  3. A lock-in provision applies to $                      of the amount we transferred from the RPP identified in Part B of Area I, under the
     Pension Benefits Standards Act or a provincial pension benefits act (specify the act).                                     Does not apply
  4. We did not transfer $                           of the RPP single amount indicated in item 1 according to one of the following subsections:
      147.3(1) to (7). We will report this amount as the applicant's income on a T4A slip.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                     Transferor's name



               Date                                            Authorized person's signature                                                        Position or office
  Area III – Transferee's certification
  1. We have received $                         , and we have credited it to:
          the applicant's RRSP identified in Part D of Area I;
               the applicant's RRIF identified in Part D of Area I;
               the applicant's account as a member of the RPP identified in Part D of Area I; or
               the applicant's account as beneficiary under the DPSP identified in Part D of Area I.
  2. The plan to which the single amount has been transferred is registered under the Income Tax Act.
  3. We will administer the amount indicated in item 3 of Area II as a locked-in amount under the recipient fund or plan.
  4. We will issue a receipt for the amount indicated in item 4 of Area II.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                      Transferee's name


               Date                                             Authorized person's signature                                                        Position or office
T2151 E (07)                             (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
                                                          Copy 2 – For the applicant (all areas completed)
                                                                   Do not attach this copy to your income tax return
                                                           DIRECT TRANSFER OF A SINGLE AMOUNT UNDER SUBSECTION 147(19) OR SECTION 147.3
You can use this form to record a direct transfer. Tick the boxes that apply to you, and see the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

  Area I – Applicant

                                      Name                                                               Social insurance number                                         Telephone


                                                                                           Address
  If the transfer is from a deferred profit-sharing plan (DPSP), complete Parts A, C, and D below.
  If the transfer is from a registered pension plan (RPP), complete Parts B, C, and D below.
  Part A – Transfer from a DPSP
               I am an employee or former employee who is a beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of an employee or former
               employee who was the beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner of an employee or former employee who was the beneficiary of
               the DPSP requesting a transfer because of a breakdown of our marriage or common-law partnership.


           Canada Revenue Agency's DPSP registration number                                                                  Employer's name



                              Plan number                                                                                   Employer's address

  Part B – Transfer from an RPP
               I am a member of the RPP.

               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of a member of the RPP.

               I am the RPP member's current or former spouse or common-law partner requesting a transfer because of a breakdown of the marriage
               or common-law partnership.


            Canada Revenue Agency's RPP registration number                                                                  Employer's name


                              Plan number                                                                                   Employer's address
  Part C – Description of amount to be transferred
               Please transfer my whole entitlement under the plan identified in Part A or B.


               Please transfer $                                    , which is my partial entitlement under the plan identified in Part A or B.

  Part D – Identification of the RRSP, RRIF, RPP, or DPSP the funds are being transferred.
               Please transfer the RPP or DPSP single amount to my registered retirement savings plan (RRSP).

                         Individual plan number                                                             Name of plan and approved specimen plan number

               Please transfer the RPP or DPSP single amount to my registered retirement income fund (RRIF).

                         Individual fund number                                                             Name of fund and approved specimen fund number

               Please transfer the RPP or DPSP single amount to my account as a member of this RPP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number

               Please transfer the DPSP single amount to my account as a beneficiary under this DPSP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number



                                                                                     Transferee's address


                      Date                                                                Applicant's signature

 Area II – Transferor's certification
  1. The $                                   transferred is the applicant's           whole or              partial entitlement under:
          the DPSP identified in Part A of Area I, or   the RPP identified in Part B of Area I.
  2. We have transferred $                          according to:
               subsection 147(19) (a DPSP lump-sum transfer to an RPP, an RRSP, a RRIF, or another DPSP); or
               one of the following subsections: 147.3(1) to (8) (an RPP lump-sum transfer to an RRSP, a RRIF, or another RPP).
  3. A lock-in provision applies to $                      of the amount we transferred from the RPP identified in Part B of Area I, under the
     Pension Benefits Standards Act or a provincial pension benefits act (specify the act).                                     Does not apply
  4. We did not transfer $                           of the RPP single amount indicated in item 1 according to one of the following subsections:
      147.3(1) to (7). We will report this amount as the applicant's income on a T4A slip.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                     Transferor's name



               Date                                            Authorized person's signature                                                        Position or office
  Area III – Transferee's certification
   1. We have received $                         , and we have credited it to:
           the applicant's RRSP identified in Part D of Area I;
               the applicant's RRIF identified in Part D of Area I;
               the applicant's account as a member of the RPP identified in Part D of Area I; or
               the applicant's account as beneficiary under the DPSP identified in Part D of Area I.
  2. The plan to which the single amount has been transferred is registered under the Income Tax Act.
  3. We will administer the amount indicated in item 3 of Area II as a locked-in amount under the recipient fund or plan.
  4. We will issue a receipt for the amount indicated in item 4 of Area II.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                      Transferee's name


               Date                                             Authorized person's signature                                                        Position or office
T2151 E (07)                             (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
                                                                      Copy 3 – For the transferee (all areas completed)
                                                           DIRECT TRANSFER OF A SINGLE AMOUNT UNDER SUBSECTION 147(19) OR SECTION 147.3
You can use this form to record a direct transfer. Tick the boxes that apply to you, and see the back of this form for instructions and definitions.
Legislative references on this form are from the Income Tax Act.

  Area I – Applicant

                                      Name                                                               Social insurance number                                         Telephone


                                                                                           Address
  If the transfer is from a deferred profit-sharing plan (DPSP), complete Parts A, C, and D below.
  If the transfer is from a registered pension plan (RPP), complete Parts B, C, and D below.
  Part A – Transfer from a DPSP
               I am an employee or former employee who is a beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of an employee or former
               employee who was the beneficiary of the DPSP.
               I am a current or former beneficiary spouse or common-law partner of an employee or former employee who was the beneficiary of
               the DPSP requesting a transfer because of a breakdown of our marriage or common-law partnership.


           Canada Revenue Agency's DPSP registration number                                                                  Employer's name



                              Plan number                                                                                   Employer's address

  Part B – Transfer from an RPP
               I am a member of the RPP.

               I am a current or former beneficiary spouse or common-law partner requesting a transfer because of the death of a member of the RPP.

               I am the RPP member's current or former spouse or common-law partner requesting a transfer because of a breakdown of the marriage
               or common-law partnership.


            Canada Revenue Agency's RPP registration number                                                                  Employer's name


                              Plan number                                                                                   Employer's address
  Part C – Description of amount to be transferred
               Please transfer my whole entitlement under the plan identified in Part A or B.


               Please transfer $                                    , which is my partial entitlement under the plan identified in Part A or B.

  Part D – Identification of the RRSP, RRIF, RPP, or DPSP the funds are being transferred.
               Please transfer the RPP or DPSP single amount to my registered retirement savings plan (RRSP).

                         Individual plan number                                                             Name of plan and approved specimen plan number

               Please transfer the RPP or DPSP single amount to my registered retirement income fund (RRIF).

                         Individual fund number                                                             Name of fund and approved specimen fund number

               Please transfer the RPP or DPSP single amount to my account as a member of this RPP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number

               Please transfer the DPSP single amount to my account as a beneficiary under this DPSP.

                                                  Employer's name                                                                  Canada Revenue Agency's registration number



                                                                                     Transferee's address


                      Date                                                                Applicant's signature

 Area II – Transferor's certification
  1. The $                                   transferred is the applicant's           whole or              partial entitlement under:
          the DPSP identified in Part A of Area I, or   the RPP identified in Part B of Area I.
  2. We have transferred $                          according to:
               subsection 147(19) (a DPSP lump-sum transfer to an RPP, an RRSP, a RRIF, or another DPSP); or
               one of the following subsections: 147.3(1) to (8) (an RPP lump-sum transfer to an RRSP, a RRIF, or another RPP).
  3. A lock-in provision applies to $                      of the amount we transferred from the RPP identified in Part B of Area I, under the
     Pension Benefits Standards Act or a provincial pension benefits act (specify the act).                                     Does not apply
  4. We did not transfer $                           of the RPP single amount indicated in item 1 according to one of the following subsections:
      147.3(1) to (7). We will report this amount as the applicant's income on a T4A slip.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                     Transferor's name



               Date                                            Authorized person's signature                                                        Position or office
  Area III – Transferee's certification
   1. We have received $                         , and we have credited it to:
           the applicant's RRSP identified in Part D of Area I;
               the applicant's RRIF identified in Part D of Area I;
               the applicant's account as a member of the RPP identified in Part D of Area I; or
               the applicant's account as beneficiary under the DPSP identified in Part D of Area I.
  2. The plan to which the single amount has been transferred is registered under the Income Tax Act.
  3. We will administer the amount indicated in item 3 of Area II as a locked-in amount under the recipient fund or plan.
  4. We will issue a receipt for the amount indicated in item 4 of Area II.
  I certify that the information given on this form is, to the best of my knowledge, correct and complete.

                                                                                      Transferee's name


               Date                                             Authorized person's signature                                                        Position or office
T2151 E (07)                             (Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou au 1-800-959-3376.)
                                                                    Copy 4 – For the transferor (Areas I and II completed)
                                                                     Instructions
Who can use this form?

If you are a DPSP trustee or an RPP administrator, you can use this form to record the direct transfer of a single amount for an applicant.
    As a DPSP trustee, you can make a direct transfer to another DPSP, an RPP, an RRSP, or a RRIF.
    As an RPP administrator, you can make a direct transfer to another RPP, an RRSP, or a RRIF.

Note
If you do not use Form T2151 to document this transfer, ensure that you, as the transferor, provide the transferee with the information required to
correctly complete the transfer.


Who completes this form?

Area I
The plan member or beneficiary requesting the transfer (the applicant) completes and signs Area I. All copies have to be given to the
DPSP trustee or the RPP administrator from which the amount is to be transferred (the transferor).

Area II
The transferor completes and signs Area II. The transferor keeps copy 4, and sends copies 1, 2, and 3 to the DPSP trustee, the RPP
administrator, the RRSP issuer, or the RRIF carrier to which the single amount is to be transferred (the transferee), along with the amount
being transferred.

Area III
The transferee completes and signs Area III of copies 1, 2, and 3. The transferee keeps copy 3, and returns copy 1 to the transferor and
copy 2 to the applicant.


Transfers from a DPSP
As the transferor, you can transfer a single amount for an employee or former employee who participated in the plan as described in
subsection 147(19). You can transfer the amount to an RPP for that person's benefit, to an RRSP or a RRIF under which that person is the annuitant.
Also, you can transfer the amount to another DPSP for that person's benefit, if it can reasonably be expected that the recipient DPSP will have at
least five beneficiaries throughout the year in which you make the transfer.

Similarly, you can transfer a single amount for the current or former spouse or common-law partner of the employee or former employee,
if that person is entitled to the amount:
    because the employee or former employee died; or
    because the marriage or common-law partnership with the employee or former employee breaks down. In this case, the transfer has to result from
    a decree, order, or judgment of a competent tribunal, or from a written separation agreement that relates to a division of property in settlement
    of rights arising out of, or on the breakdown of, the marriage or common-law partnership.

Do not include the amount that you transfer under subsection 147(19) in the income of the person for whom you made the transfer. Also, that person
cannot deduct the amount transferred. Do not issue a T4A slip or a receipt for the amount.

Do not withhold income tax from an amount you transfer under subsection 147(19).

Transfers from an RPP
As the transferor, you can transfer a single amount for a plan member to another RPP for the member's benefit, or to the member's RRSP or RRIF.
See section 147.3 for the details of such transfers.

You can transfer a single amount for the member's current or former spouse or common-law partner, if that person is entitled to the amount:
  because the member dies; or
  because the marriage or common-law partnership with the member breaks down. In this case, the transfer has to result from a decree,
  order, or judgment of a competent tribunal, or from a written separation agreement that relates to a division of property in settlement
  of rights arising out of, or on the breakdown of, the marriage or common-law partnership.

In certain cases, the rules in section 147.3 limit the amount that you can transfer without tax consequences. If part of an amount transferred does not
meet the rules of the subsection under which you transfer, that part is considered to have been paid to the applicant as a pension benefit. In such
cases, you have to report that part as the applicant's income on a T4A slip. That part is also considered to have been contributed by the applicant to the
RRSP or to the other RPP, whichever applies. The transferee should give the applicant a receipt for the amount.

Similarly, if you transfer the single amount to a RRIF, the excess part is considered to have been contributed to an RRSP. In such cases, you have to
report the excess part as the applicant's income on a T4A slip. The transferee should give the applicant an RRSP receipt for the excess part.

Do not include the amount that you transfer under any of subsections 147.3(1) to (8) in the income of the person for whom you make the transfer.
Also, that person cannot deduct the amount transferred. Do not issue a T4A slip or a receipt for the amount.

Do not withhold income tax from the amount you transfer under section 147.3.

                                                                      Definitions
Annuitant – The person who is entitled to receive payments from an RRSP or a RRIF.

DPSP trustee – A corporation named as a trustee under the plan, that is resident in Canada, and licensed or otherwise authorized under Canadian law
               to carry on in Canada the business of offering to the public its services as a trustee. A DPSP trustee can also mean a group of at
               least three individuals who are resident in Canada, and who are named as trustees under the plan.

Individual plan number or individual fund number – The individual account, contract, certificate, or other identifier number that the RRSP issuer or
                                                       RRIF carrier assigns.
RPP administrator – The person or organization that is responsible for administering the RPP.

RRIF carrier – A person described in subsection 146.3(1), with whom an annuitant has an arrangement that is a RRIF.

RRSP issuer – A person described in subsection 146(1), with whom an annuitant has a contract or arrangement that is an RRSP.

Single amount – An amount that is not part of a series of periodic payments.

Spouse or common-law partner – You can find the definition of these terms in most of the income tax guides or pamphlets we publish.

Transferee – The administrator, issuer, or trustee of the plan, or the carrier of the fund to whom the amount is transferred.

Transferor – The administrator or trustee of the plan from whom the amount is transferred.


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