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Public Service Superannuation Regulations (C.R.C., c. 1358)

Regulations are current to 2024-05-28 and last amended on 2021-06-10. Previous Versions

SCHEDULE V

FORM A

Superannuation Number

SUPERANNUATION BRANCH

Department of Finance

Public Service Superannuation Act

NOTICE OF COURT ORDER

Applicable to Subsection 20(2) of the

Public Service Superannuation Act

CourtProvinceDate of Order
Name of RecipientAmount and Method of Payment
Lump Sum
☐ $blank line or ☐ $blank line per blank line
Name of DependentRelationship of Dependent to Recipient
Statute or other Authority under which Order was made

THE PRESIDENT OF THE TREASURY BOARD

OTTAWA, CANADA.

In compliance with the above-mentioned order, (a certified copy of which is attached hereto), and pursuant to subsection 20(2) of the Public Service Superannuation Act, I hereby request that you pay the amount specified herein to the above-named dependent by deductions from any amount that is or becomes payable to the recipient under the Public Service Superannuation Act.

blank line
(Registrar, Prothonotary, Clerk or other officer of the Court authorized to issue this notice on behalf of the Court)
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Date

Form No. blank line

  • SOR/93-450, s. 11(F)
 

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