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Here you will find a collection of forms related to your pension and insurance benefits plans. To use the forms below, you must first print the form, complete it by hand and return it by mail to the following address:

Public Works and Government Services Canada
Government of Canada Pension Centre - Mail Facility
PO Box 8000
Matane QC G4W 4T6

You may also obtain these forms and others by contacting the Government of Canada Pension Centre.

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Table of Contents

Dental Care Plan

Standard Claim Forms

Disability Insurance

Standard Claim Forms

Public Service Health Care Plan

Standard Claim Forms

Comprehensive Coverage Claim Forms

Public Service Management Insurance Plan

Death Benefit

Long-term Disability Insurance

Post Retirement Life Insurance Plan

Public Service Pension Plan

Leave Without Pay

Pension Benefits Division

Retirement/Termination of
Employment

Other Forms

If you wish to increase your tax credit beyond the basic personal amount, please complete the TD1 Personal Tax Credits Return form as well as the corresponding provincial form below.

TD1 Personal Tax Credits Return

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories

Nova Scotia

Nunavut

Ontario

Prince Edward Island

Quebec

Saskatchewan

Yukon

Service Buyback

  • Form 570 - Payment Transmittal Form
    Complete this form to send your payments in respect of a period of leave without pay and/or a service buyback.
  • Form 2005 - Service Buyback form for Transfer Value Service
    Complete this form if you wish to buy back prior service for which you received a Transfer Value.
  • Form 2069 - Pensionable Employment Questionnaire
    Have your former employer complete this form if you are buying back prior service outside the federal public service.
  • Form 2092 - Surrender of Benefits PWGSC
    Complete this form if you wish to surrender your benefits under the Canadian Forces or the Royal Canadian Mounted Police and have that service counted as pensionable service under the public service pension plan.
  • Form 3006 - Service Buyback form PWGSC
    Complete this form if you wish to buy back prior service and have it counted as pensionable under the public service pension plan.

Supplementary Death Benefit

Naming or Substitution of a Beneficiary

Reduce Benefit

  • Form 2041-1 - Election to Reduce Benefit to $10,000
    Complete this form if you are preparing for retirement and you wish to reduce your Supplementary Death Benefit coverage to $10,000.00.

Standard Claim Form

Survivor

Declaration Forms

Forms Available from your Compensation Advisor

Below is a list of additional forms that you may require; however, they are only available from your Compensation Advisor.

Disability Insurance

  • Form 330-303 - Claim for Disability Insurance – Employer's Statement Policy No. 12500-G TBS

Public Service Management Insurance Plan

Basic Life Insurance

  • Form 2028 - Public Service Management Insurance Plan PWGSC
  • Form 2028-5 - Public Service Management Insurance Plan Part-time employee only PWGSC

Change of Name or of Beneficiaries

  • Form 2028-1 - Public Service Management Insurance Plan (Change of Name or of Beneficiaries) PWGSC

Long-term Disability Insurance

  • Form 2027 - Long-term Disability Insurance – Public Service Management Insurance Plan PWGSC
  • Form 2027-1 - Long-term Disability Insurance – Public Service Management Insurance Plan (Part-time Employee Only) PWGSC

PSMIP Supplementary Life Insurance

  • Form 2028-7 - Public Service Management Insurance Plan – Members Entitled to Government-Paid Coverage PWGSC

Forms Available from the Government of Canada Pension Centre

Below is a list of additional forms that you may require; however, they are only available from the Government of Canada Pension Centre.

  • Form 2011E-PF - Pension Benefit Options Statement PWGSC
    This form is used to indicate your pension option.
  • Form 439E - Pensioners' Dental Services PWGSC