CF-FC 2460—Application for Diversion

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Privacy notice

Provision of the personal information including the social insurance number (SIN) 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 supplementary death benefits, Canada Revenue Agency (CRA)/Revenu Québec (RQ) reporting and 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.

Note

This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.

Plan member's personal information

Preferred language

Please provide the following information concerning the recipient of the pension benefit

Check the applicable acts or regulations under which the recipient is entitled to a pension (if known)

Please provide the following information concerning the applicant (the person named in the court order as being entitled to financial support)

Will the applicant have custody and control of another person entitled to financial support from the recipient?

If yes, please indicate name and address.

Will the applicant have someone acting on his/her behalf (e.g. a lawyer)?

If yes, please indicate full name, and address, and their legal relationship.

Is this form being completed by the acting person?

Diversion payment made to a person other than the applicant (e.g. family court). Identify the person named in the financial support order

Documentation

The original or certified true copy of the financial support order under which this application is made must be attached.

If the name on the financial support order is not the same as the name of the applicant (identified on the previous page), then you must provide either:

  1. a certified copy of the certificate evidencing the change where a formal change of name has occurred Or
  2. a statutory declaration by the person making this application as to the circumstances concerning the difference in any other case

If the name on the financial support order is the same as the name of the applicant (identified on the previous page) and this person is a child then you must provide:

  1. a child birth certificate Or
  2. a certified true copy of proof of birth

Authorization

I hereby request the Minister of Public Works and Government Services Canada to divert from the recipient's net pension benefit an amount calculated in accordance with the provisions of the "Garnishment, Attachment and Pension Diversion Act" and Regulations.

Note: Mail the completed application to:

Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
Post Office (PO) Box 9500 
Matane QC G4W 0H3

For office use only

CF-FC 2460E (2014-12-001)

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