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CF-FC 2440E (2015-03-001)

STDHDR

FOR OFFICE USE ONLY

Case NumberForm Number

u

English French

Surname

Given Names

Home Address

Pension Number

Service Number

Email address (optional)

Postal Code Country

Apartment Number

City Province

Preferred LanguageDate of Birth (YYYYMMDD)

Public Works and Government Services Canada

Travaux publics et Services gouvernementaux Canada

PROTECTED "B" when completed

Canadian Forces Superannuation Act Regular/Reserve Force – Record of Canadian Forces Service (CF)

Plan Member's Personal Information

This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.

Rank

Preferred Telephone Number

Privacy Notice Provision of the personal information is required pursuant to the Department of Public Works and Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of administrating the Canadian Forces Superannuation Act (CFSA). Refusal to provide the personal information, or the provision of incorrect information may result in loss of benefits and/or delays in processing incorrect pension estimates, benefits, or statements. Personal information is protected, and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 – Federal Pension Administration. Under the Act, individuals have a right of access to and request correction of their personal information, if erroneous or incomplete.

Service Number Pension NumberForm NumberFOR OFFICE USE ONLY

CF-FC 2440E (2015-03-001)

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Part 2 - Canadian Forces Service

1. To receive an Immediate Annuity (pension), a Regular/Reserve Force member must complete 25 years of Canadian Forces Service (this includes periods of previous Reserve and Regular Force service). Canadian Forces Service is counted as actual time served and when earnings (pay) have been received for the period served. For example, a Reserve member may have a one full year of Pensionable Service but only a few weeks Canadian Forces Service. As long as a member works one day in a year, they are credited with a year of Pensionable Service. A Reserve member is only credited with the days actually worked in the year as Canadian Forces Service.

2. For Regular Force members, Canadian Forces Service is the total time service plus Reserve time, if applicable.

3. Canadian Forces service is calculated as follows:

a. All periods of Regular Force service (all time is counted one for one);

b. Class A - Total all Class A days worked, half days are to be added together to get the equivalent of one full (training) day. The total number of days will be rounded up to the next integer, then multiplied by 1.4;

c. Class B and C - Total all Class B and C days together, they are one for one; and

d. Add Regular and Reserve Service (Class A, B and C) together. This will give the total Canadian Forces Service the member has.

Part 3 - Record of Canadian Forces Service

4. A Record of Canadian Forces Service is completed when a member has requested a re-calculation of Canadian Forces service. A re-calculation may be done for various reasons:

5. Complete the table below listing your periods of service (Regular or Reserve Force), include all periods of Enrolment, Release and Transfers (ie: SRR). Supporting documentation for each period of Canadian Forces Service must accompany this form. Examples of supporting documentation are: Pay Account info (not originals), Route Letter, Attendance Records, Peoplesoft/MPRR (see pension website for a checklist of source documentation.

a. "It has been determined that I am entitled to a Transfer Value / Deferred Annuity as I do not have 25 years of Canadian Forces Service. I wish to count the following non-elected Canadian Forces service in order to be entitled to an immediate annuity with 25 years of Canadian Forces Service."

b. "My elective service has been counted as ¼ time for Canadian Forces Service calculation purposes. I wish to count my elective service in actual Canadian Armed Forces paid days in order to be entitled to an Immediate Annuity (IA) with 25 years of Canadian Forces Service."

(This form is to be used to re-calculate a member Canadian Forces service, including non-elective service)

Service Number Pension NumberForm NumberFOR OFFICE USE ONLY

CF-FC 2440E (2015-03-001)

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**Note: Periods of Canadian Forces Service are: Reserve Class A (two ½ days = 1 day), B, C, Regular Force, LWOP(M), ED&T(M), LWOP(P), ED&T(P), Forfeiture (less than 60 days), Detention (less than 60 days), Spousal Accompaniment, Disability Periods (Class A & B).

Type of Service Start Date Cease Date Total Paid Days/Years

Member's Signature

(Date yyyy-mm-dd)(Name and Initials)

6. All period of Canadian Forces Service have been evaluated. Listed below are periods of service not counted as Canadian Forces Service.

Part 4 - Periods of Non Canadian Forces Service (Completed by Government of Canada Pension Centre)

Period of Service Start Date Cease Date

Total Number of Days Not Counted as Canadian Forces

Service

Reason (state if not valid in CFSA Part I.1

or not considered Canadian Forces Service)

Service Number Pension NumberForm NumberFOR OFFICE USE ONLY

Page 4 of 4CF-FC 2440E (2015-03-001)

Part 5 - Record of Canadian Forces Service (completed by Government of Canada Pension Centre)

Canadian Force Service Effective from 1 April 1999 to )

Total LWOP(Other)

Total Canadian Forces Service (all types of service) as of is

Total ED&T(M) Total Disability Period

Total LWOP(M) Total Spousal Accomp.

Total Regular Force Total Detention

Total Class C Total Forfeiture

Total Class B Total ED&T(P)

Total Class A (x 1.4) Total LWOP(P)

Government of Canada Pension Centre Date

Verification By:

Part 6 - Corrective Action (if applicable)

7. Corrections have been actioned effective Government of Canada Pension Centre

Voucher NumberDate (yyyy-mm-dd)