Request for Eligibility Review Canadian Forces Superannuation Act: CF-FC 2441

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Provision of the personal information is required pursuant to the Department of Public Works and Government 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 their personal information and request correction, if erroneous or incomplete.

Note

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

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CF-FC 2441 – Request for Eligibility Review Canadian Forces Superannuation Act [PDF - 1.2 MB]

Protected "B" when completed

Plan member's personal information

Rank

Surname

Given Names

Plan member's personal information Pension Number

Date of Birth (YYYY-MM-DD)

Preferred language

English French

Service Number

Home address

Apartment Number

Preferred Telephone Number (999‑999‑9999)

City

Province

Postal Code

Country

Email Address (optional)

Part 1—Election Information (Completed by Member)

Current Enrolment
Date (YYYY-MM-DD)

Base/Unit/Element

Unit Orderly Room Telephone Number

Request a review/re-calculation of eligibility to:
Participate in the (RFPP) (Part I.1) or

Contribute to the CFSA Part I
Currently, the date of my eligibility is , I disagree with this date for the following reason: (Choose one)
I have service/earnings that were processed by Miscellaneous Vouchers that should be taken into consideration for eligibility purposes.

The enrolment date used to calculate my eligibility is invalid, my last enrolment date was
(YYYY-MM-DD)

I wish to have my eligibility date re-evaluated as I have re-enrolled in the Canadian Armed Forces within 90 days of my release date.

I must contribute to Part I of the CFSA as I transferred to the Reserve Force within 90 days of being released from the Regular Force, I am vested but not entitled to an immediate annuity.

I should not be a participant as I have been released from the Canadian Armed Forces for a period of greater than 61 days.

I was formerly a Part I contributor of the CFSA for which I have received a Transfer Value. I should be eligible for Part I of the CFSA not the RFPP (Part I.1)

I should be eligible immediately as I have former Canadian Forces Service for which I opted for a Deferred Annuity (DA).

I should be eligible immediately as I have former Canadian Force Reserve Service for which I am in receipt of an annuity.

I wish to exercise my right to join the CFSA Part I immediately on a voluntary basis as I have former Canadian Force Regular Service for which I am in receipt of an annuity.

I am required to contribute to CFSA Part I immediately as I have former Canadian Force Regular Service for which I am in receipt of an annuity and have more than 365 days of continuous paid service since my last Canadian Armed Forces enrolment.

I am a contributor under the PSSA/RCMPSA, therefore, I must remain under the RFPP (Part I.1) even though I meet the CFSA Part I eligibility criteria.

I am a contributor under the PSSA/RCMPSA and have opted for a DA from previous CFSA Part I service; I cannot join either CFSA Part I or RFPP (Part I.1).

I am a contributor under the PSSA/RCMPSA and may not contribute to the CFSA Part I. Request reversion back to the Reserve Force Pension Plan (Part I.1).

Other

Other2

Notes:

Source documentation is required to support your request. Examples of source documents are: Pay Account info (not originals), Attendance Records, Peoplesoft/MPRR (see Pension website for a checklist of source documentation)
Invalid eligibility determination resulting from missing service/earnings or deemed service/earnings in the pay system should be referred to your unit pay office for validation and processing

Signature of Member

Date (YYYY-MM-DD)

Part 2—Eligibility Review (completed by Government of Canada Pension Centre)

A review of your Eligibility date has been completed. Members' eligibility date to:
Participate in RFPP or

Contribute to CFSA Part I

is

Attached is the verification of your period of qualifying service

Name and Initials Date (YYYY-MM-DD)

Part 3—Correction Action (completed by Government of Canada Pension Centre)

Correction have been actioned effective

Name and Initials

Date (YYYY-MM-DD)

Voucher Number

Canadian Forces Superannuation Act Reserve Force—Request for Eligibility Review Annex

Type of Service	Start Date	Cease Date	Total Days Paid	Unit
type1	start1	end1	days1	unit1
type2	start2	end2	days2	unit2
type3	start3	end3	days3	unit3
type4	start4	end4	days4	unit4
type5	start5	end5	days5	unit5
type6	start6	end6	days6	unit6
type7	start7	end7	days7	unit7
type8	start8	end8	days8	unit8
type9	start9	end9	days9	unit9
type10	start10	end10	days10	unit10
type11	start11	end11	days11	unit11
type12	start12	end12	days12	unit12
type13	start13	end13	days13	unit13
type14	start14	end14	days14	unit14
type15	start15	end15	days15	unit15
type16	start16	end16	days16	unit16
type17	start17	end17	days17	unit17
type18	start18	end18	days18	unit18
type19	start19	end19	days19	unit19
type20	start20	end20	days20	unit20
type21	start21	end21	days21	unit21
type22	start22	end22	days22	unit22
type23	start23	end23	days23	unit23

Signature

Date (YYYY-MM-DD)

For office use only

Form Number

Case Number

Service Number

Pension Number

CF-FC 2441E (2015-02-001)

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Request for Eligibility Review Canadian Forces Superannuation Act: CF-FC 2441

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Plan member's personal information

Part 1—Election Information (Completed by Member)

Part 2—Eligibility Review (completed by Government of Canada Pension Centre)

Part 3—Correction Action (completed by Government of Canada Pension Centre)

Canadian Forces Superannuation Act Reserve Force—Request for Eligibility Review Annex

For office use only

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