Public Services and Procurement Canada
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Provision of the information requested on this document is voluntary. This information is being collected in accordance with the Public Service Superannuation Act (PSSA) to buyback transfer value service. This information will be stored in Personal Information Bank number PWGSC PCE 702 and will be protected, used and disclosed in accordance with the Privacy Act. Under the Act, you have the right to request access to your personal information and to request corrections should you believe the information contains errors or omissions. Personal information that you provide about another individual may be accessible to that person under the Privacy Act. The records will be retained by the Department for two years following the last administrative action, and then will be destroyed.
This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.
Carefully read the Instructions before completing this form.
To be completed by the plan member. Retain 1 copy for your records and forward the original by registered mail to:
Note: The Public Service Pension Centre will only reinstate the most recent period(s) of pensionable service corresponding to the amount received.
Important: "PAYMENT METHOD" see number 4 on the instructions page.
I hereby choose to pay to reinstate past transfer value in a lump sum payment. If the amount received is less than the full cost required to reinstate the full previous transfer value service, then I agree that only a portion of the service will be reinstated.
I understand that, if the lump sum paid is greater than the contribution required, a refund will be made.
Care should be taken when completing this form since, under most circumstances, a service buyback is a binding, irrevocable agreement. Please ensure that the dates of the service which you enter are complete and accurate. If you have received more than one transfer value payment then the service of the most recent transfer value must be purchased in its entirety first.
You must sign and forward your service buyback within one year from the date of issue of the "Notification of Plan Membership" (PWGSC-TPSGC 2018) that you have received.
The completed service buyback form must be forwarded to the following address:
Public Service Pension Centre - Mail Facility 150 Dion Blvd P.O. Box 8000 Matane QC G4W 4T6
Use of registered mail is recommended. If sent by registered mail, the receipt of registration should be kept for your records. The date on which this form is mailed must be indicated in the space provided.
In order to validate a service buyback for reinstatement of transfer value service, you must undergo a medical examination within 90 days prior to or 6 months after the service buyback form is signed. Your physician must forward the required medical forms to the Regional Medical Services Office (Health Canada) as indicated on the medical examination forms.
Only payments received within 90 days of the date the service buyback is received by the Minister will be accepted and used to calculate the pensionable service that can be reinstated.
A PSPA must be calculated for all buybacks with post-1989 service. Where the Canada Revenue Agency (CRA) does not approve the PSPA, the service buyback will be declared invalid.
Return to footnote * referrer
PWGSC-TPSGC 2005 (09/2009)
