Privacy notice
Provision of the personal information is required pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of administrating the Canadian Forces Superannuation Act (CFSA). Refusal to provide the personal information, or the provision of incorrect information may result in loss of benefits and/or delays in processing incorrect pension estimates, benefits, or statements. Personal information is protected, and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 – Federal Pension Administration. Under the Act, individuals have a right of access to their personal information and request correction, if erroneous or incomplete.
Plan member's personal information
Complete and mail the form to the address indicated below with a "VOID" cheque
in the amount of
$
I understand the amount debited from my (our) account maybe increased once the election has been verified.
Pre-Authorized Debit will begin on the 1st of the following month in which the election is dated.
I hereby authorize my (our) financial institution to process a debit on my (our) account for all amounts required by the Government of Canada Pension Centre for payment of my election.
In the event you change your bank account, you will notify the Government of Canada Pension Centre no less than 30 business days prior to the next instalment date and provide a current cheque marked "VOID" or Lump Sum cheque for any remaining buyback balance. If you action a stop payment, close your bank account or if a NFS occurs, Government of Canada Pension Centre will process the defaulted payment by utilizing the data received from the Office of the Superintendant of Financial Institutions to provide a final amortization, and the principle including the interest will be added to the final buyback amount. If no action is taken on your defaulted service buyback, interest of 4% a year will be charged on your defaulted payments. This may result in a substantially higher monthly amount to be deducted from your pension when it becomes payable. In addition, your defaulted payments will not be life-insured unless your delayed payments are large enough to pay off the full balance by the original final payment date.
I understand that in the event I change my bank account, I will notify the Government of Canada Pension Centre no less than 30 business days prior to the next instalment date and provide a current cheque mark "VOID" or Lump Sum cheque for any remaining buyback balance. If no action is taken on your defaulted service buyback, interest of 4% a year will be charged on your defaulted payments. This may result in a substantially higher monthly amount to be deducted from your pension when it becomes payable. In addition, your defaulted payments will not be life-insured unless your delayed payments are large enough to pay off the full balance by the original final payment date.
Authorizing signature(s)
All person whose signatures are required to sign on the bank account listed on this form must sign this form.
You, the Payor, may revoke your authorization at any time (Payee to insert process - e.g. in writing or by phone) subject to providing notice of changes or termination. The notification must be receive at least 30 days before the next debit is scheduled. To obtain a sample cancellation form, or for more information on your right to cancel a Pre-authorized Debit (PAD) Agreement, contact your financial institution or visit: www.cdnpay.ca
You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit: www.cdnpay.ca
Formulaire disponible en Français CF-FC 2444F
Mail to: (with blank cheque marked "VOID")
Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
PO Box 9500
Matane QC G4W 0H3
