Canadian Forces Superannuation Regulations (C.R.C., c. 396)

(This election form must be completed and sent to a person designated by the Minister within the prescribed time.)

PART IElection to Pay for Pensionable Service

• SECTION A 

  Personal information of the contributor making the election.

  (Rank)(Given names) (Last name)

  (Service number)

• SECTION B 

  A contributor making an election to pay for pensionable service, other than the service referred to in section C.

  • 1 I elect, under subsection 7(1) of the Canadian Forces Superannuation Act, to pay for the following service (indicate your choice in the appropriate box):

    • ☐ (a) all my pensionable service;

    OR

    • ☐ (b) part of my pensionable service, the type and period of which are specified below (if the election relates to only a portion of a particular type of service, you may only elect to pay for the most recent portion of that service):

      

      

  • 2 I will make payment in the following manner (choose only ONE plan of payment and indicate your choice in the appropriate box):

    • ☐ (a) in a lump sum payment;

    OR

    • ☐ (b) in an initial payment of $ , with the balance to be paid in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid;

    OR

    • ☐ (c) in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid.

    I understand that the total amount required to pay for the service will be verified and may be subject to adjustment under the Canadian Forces Superannuation Act.

  Signed at (Place) on (Day) (Month) (Year)

  (Signature of contributor)

  Witnessed by

  (Name of witness, printed in full)

  (Signature of witness)

• SECTION C 

  A regular force member who became a contributor on or after March 1, 2007 and who elects to pay for a period of pensionable service of a kind referred to in paragraphs 12.2(1)(i) of the Canadian Forces Superannuation Regulations.

  This election is for all of the contributor’s pensionable service of a kind referred to in paragraphs 12.2(1)(i) of the Canadian Forces Superannuation Regulations.

  • 1 I understand that the estimated full amount to pay for this service is $ and that it will be verified and may be subject to adjustment under the Canadian Forces Superannuation Act (indicate your choice in the appropriate box):

    • ☐ (a) I elect to pay the full amount and if, after verification, the amount differs from the estimated amount indicated above, I will pay the full adjusted amount;

    OR

    • ☐ (b) I opt, under paragraph 12.3(1)(g) of the Regulations, to pay the lesser amount of $ and I understand that I will not be able to increase this amount at a later date and that my benefits will be proportionately reduced.

  • 2 I will make payment in the following manner (choose only ONE plan of payment and indicate your choice in the appropriate box):

    • ☐ (a) in a lump sum payment;

    OR

    • ☐ (b) in an initial payment of $ , with the balance to be paid in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid;

    OR

    • ☐ (c) in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid.

  Signed at (Place) on (Day) (Month) (Year)

  (Signature of contributor)

  Witnessed by

  (Name of witness, printed in full)

  (Signature of witness)

PART IIElection to Repay an Annuity or Annual Allowance Drawn During a Period of Service in the Reserve Force

(To be completed by a contributor who is a regular force member and who was in receipt of an annuity or annual allowance under Part I of the Canadian Forces Superannuation Act during the period of reserve force service for which they are making an election to pay.)

Personal information of the contributor making the election.

(Rank)(Given names) (Last name)

(Service number)

I elect, under subsection 12.6(1) of the Canadian Forces Superannuation Regulations, to repay the part of the annuity or annual allowance that was paid to me under the Canadian Forces Superannuation Act during the period of reserve force service for which I am making an election to pay.

I will make payment, in a lump sum, no later than 120 days after the date of the notice advising me of the amount due.

Signed at (Place) on (Day) (Month) (Year)

(Signature of contributor)

Witnessed by

(Name of witness, printed in full)

(Signature of witness)

Personal information of the contributor making the election.

(Rank)(Given names) (Last name)

(Service number)

• 1 I elect, in respect of my pensionable service described in subsection 12.9(2) of the Canadian Forces Superannuation Regulations, to surrender my right to an annuity or annual allowance under the following Act (indicate your choice in the appropriate box):

  • ☐ (a) the Public Service Superannuation Act;

  OR

  • ☐ (b) the Royal Canadian Mounted Police Superannuation Act.

  I understand that in so electing I or any person to whom a benefit might otherwise have become payable under the indicated Act will cease to be entitled to any benefit in respect of that service.

• 2 I will pay any amount remaining unpaid for the above service in the following manner (choose only ONE plan of payment and indicate your choice in the appropriate box):

  • ☐ (a) in a lump sum payment;

  OR

  • ☐ (b) in an initial payment of $ , with the balance to be paid in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid;

  OR

  • ☐ (c) in monthly instalments of $ starting on the first day of the month following the month in which this election is made and continuing until the total amount required to pay for the service and interest is fully paid.

  I understand that the total amount required to pay for the service will be verified and may be subject to adjustment under the Canadian Forces Superannuation Act.

Signed at (Place) on (Day) (Month) (Year)

(Signature of contributor)

Witnessed by

(Name of witness, printed in full)

(Signature of witness)

(To be completed by a contributor who does not wish to contribute in respect of the portion in excess of three months of a period of service in respect of which no pay was authorized (e.g., leave without pay). The election must be signed within 90 days after either the last day of that period or the day on which the contributor is required to resume making contributions under section 5 of the Canadian Forces Superannuation Act, whichever is later. A separate form must be completed for each portion in excess of three months in respect of which no pay was authorized.)

Personal information of the contributor making the election.

(Rank)(Given names) (Last name)

(Service number)

• 1 I elect not to count as pensionable service the period beginning on (Day) (Month) (Year) and ending on (Day) (Month) (Year),

  which is the portion in excess of three months of a period of service and in respect of which pay was not authorized to be paid to me because (state reasons for which no pay was authorized):

  

  

  

• 2 The entire period of service for which pay was not authorized to be paid, including the first three months for which contributions must be paid, is the period beginning on (Day) (Month) (Year) and ending on (Day) (Month) (Year).

• 3 I understand that the period of service described in section 1, which is the portion that is in excess of three months, will NOT be counted as pensionable service for computing any benefit under the Canadian Forces Superannuation Act.

Signed at (Place) on (Day) (Month) (Year)

(Signature of contributor)

Witnessed by

(Name of witness, printed in full)

(Signature of witness)