Here you will find a collection of forms related to your pension and insurance benefits plans. To use the forms below, you must first print the form, complete it by hand and return it by mail to the following address:

Public Works & Government Services Canada
Public Service Pension Centre – Mail Facility
150 Dion Blvd
PO Box 8000
Matane QC G4W 4T6

You may also obtain these forms and others by contacting the Public Service Pension Centre.

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Table of Contents

• Public Service Health Care Plan (PSHCP)
• Public Service Pension Plan
  • Survivor

Public Service Health Care Plan (PSHCP)

006482

Claim Form TBS
Complete this form if you are a member and wish to make a claim for eligible health care expenses from the PSHCP.

006483

Claim Form for Comprehensive Coverage TBS
Complete this form if you are a member and wish to make a claim for eligible out of Country health care expenses from the PSHCP.

006492 (PDF, 91KB)

Public Service Health Care Plan – Pensioner Application TBS (PDF, 91KB)
Complete this form if you wish to apply for coverage under the PSHCP as a pensioner.

Public Service Pension Plan

Survivor

2002 (PDF, 117KB)

Declaration of Attendance at an Educational Institute PWGSC (PDF, 117KB)
Complete this form if you are an eligible dependant of a deceased plan member of the public service pension plan and are requesting a Student Allowance. Note: Form is only valid if printed on legal size paper (81/2 X 14)

2010 (PDF, 1.46MB)

Statutory Declaration – Statement of the person having custody of the surviving children PWGSC (PDF, 1.46MB)
Complete this form if you are the person who has custody of the surviving child of a deceased member and are applying for the children's allowance.

2467 (PDF, 272KB)

Statutory Declaration – Claimant's Statement PWGSC (PDF, 272KB)
Complete this form if you are making a claim for a survivor pension as the common-law partner of a deceased plan member.

2467-1 (PDF, 264KB)

Statutory Declaration – Supporting Statement PWGSC (PDF, 264KB)
Have two persons who know of your common-law relationship each complete this form in support of your claim for a survivor pension as a common-law partner of a deceased plan member.