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

(This election must be completed and forwarded to a commanding officer or other person designated by the Minister within the prescribed time limit.)

PART IElection To Pay for Pensionable Service

• SECTION A 

  Personal information of 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 paragraph 6(b) or subsection 42(1) or 43(1) of the Canadian Forces Superannuation Act to pay for (indicate choice in the appropriate box):

    • ☐ (a) all my pensionable service;

    OR

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

        

        

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

    • ☐ (a) by a lump sum payment;

    OR

    • ☐ (b) by a lump sum payment of $ , 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) by 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 to pay for the service will be verified and may be subject to adjustment under the Act.

  Signed at (Place) on (day) (month) (year)

  (Signature of Contributor)

  Witnessed as to signature of contributor 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 pensionable reserve force service under clause 6(b)(ii)(G) or (H) of the Canadian Forces Superannuation Act, as adapted by subsection 12.2(2) of the Canadian Forces Superannuation Regulations.

  This election is for all of the contributor’s pensionable reserve force service. The contributor may opt, under paragraph 7(1)(g) of the Act, as adapted by subsection 12.4(1) of the Canadian Forces Superannuation Regulations, to pay less than the full amount for this service and any related benefit will be proportionately reduced.

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

    • ☐ (a) I elect to pay the full amount and I acknowledge that if the verified amount to pay for this service differs from the estimated amount indicated above, I will pay the verified full amount;

    OR

    • ☐ (b) I opt, under paragraph 7(1)(g) of the Act as adapted by subsection 12.4(1) of the Canadian Forces Superannuation Regulations, to pay the lesser amount of $ . 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 choice in the appropriate box):

    • ☐ (a) by a lump sum payment;

    OR

    • ☐ (b) by a lump sum payment of $ , 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) by 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 as to signature of contributor by:

  (Name of Witness, printed in full)

  (Signature of Witness)

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

Personal information of contributor making the election

(Rank)(Given Names) (Last Name)

(Service Number)

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 the contributor is making an election to pay.

I elect, under subsection 41(4) of the Canadian Forces Superannuation Act, as adapted by section 8.4 of the Canadian Forces Superannuation Regulations, to repay the part of the annuity or annual allowance that was paid to me under that 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 as to signature of contributor by:

(Name of Witness, printed in full)

(Signature of Witness)

PARTS III AND IV

[Repealed, SOR/2016-64, s. 43]

[Repealed, SOR/2016-64, s. 44]

Personal information of contributor making the election

(Rank)(Given Names) (Last Name)

(Service Number)

• 1 I elect, in respect of my pensionable service described in subsection 46(2) of the Canadian Forces Superannuation Act, to surrender my right to an annuity or annual allowance under (indicate 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 any benefit might otherwise have become payable under the indicated Act, in respect of this service, will cease to be entitled to any benefit under that subsection.

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

  • ☐ (a) by lump sum payment;

  OR

  • ☐ (b) by lump sum payment of $ , 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) by 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 above plan of payment, 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 as to signature of contributor by:

(Name of Witness, printed in full)

(Signature of Witness)

CFSA 103

[Repealed, SOR/2016-64, s. 46]

(To be completed by a contributor who does not wish to contribute in respect of the portion of a period of service in excess of 3 months in respect of which no pay was authorized (e.g., leave without pay), pursuant to s. 6.1(1) of the Canadian Forces Superannuation Act and s. 11(2.2) of the Canadian Forces Superannuation Regulations. The election must be signed within 90 days after the end of such service or within 90 days after the day on which the contributor is required to resume making contributions under the Act, whichever is later. A separate form must be completed for each period in excess of 3 months in respect of which no pay was authorized.)

Personal information of contributor making the election

(Rank)(Given Names) (Last Name)

(Service Number)

• 1 I elect not to count as pensionable service the period from (day) (month) (year) to (day) (month) (year),

  both dates inclusive, which is the portion of a period of service that is in excess of three months 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, including the first three months for which contributions must be paid, is the period from (day) (month) (year) to (day) (month) (year).

• 3 I understand that the period of service described in section 1, which is the portion 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 as to signature of contributor by:

(Name of Witness, printed in full)

(Signature of Witness)

[Repealed, SOR/2016-64, s. 48]

[Repealed, SOR/92-717, s. 7]