PWGSC-TPSGC 2005: Service buyback form for transfer value service

The personal information is collected pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13. The personal information will be used by the Receiver General and Pension branch of Public Services and Procurement Canada for the purpose of administrating the Public Service Superannuation Act. The personal information is described in the Personal Information Bank PWGSC PCU 702 – Federal Pension Administration, and Pay and Benefit – PSE 904. Your personal information is protected, used, and disclosed in accordance with the Privacy Act. Under the Privacy Act, you have the right to access and correct your personal information, if erroneous or incomplete. The personal information provided for the pension program will be retained for a period of a minimum of 2 years after the last administrative action, and then destroyed. If you require clarification about this privacy notice, you may contact the Public Services and Procurement Canada’s Access to Information and Privacy Directorate by email at tpsgc.vieprivee-privacy.pwgsc@tpsgc-pwgsc.gc.ca. If you are not satisfied with the response to your privacy concern or if you want to file a complaint about the handling of your personal information, you may wish to contact the Office of the Privacy Commissioner.

1. Completion of Form

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.

2. Forwarding of Form

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.

3. Validation of Service Buyback

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.

4. Payment Method

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.

5. Past Service Pension Adjustment (PSPA)

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.