Medical examination certificate PDF, 710KB)
Protected "B" when completed
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 Royal Canadian Mounted Police Superannuation Act (RCMPSA) and the Royal Canadian Mounted Police Pension Continuation Act (RCMPPCA). 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.
This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.
The medical examination shall be taken within six months before or six months after the date the service buyback form is signed which includes the RCMP-GRC A-2-2E, RCMP-GRC 3006-1 and/or RCMP-GRC 3006-2.
I, the undersigned physician, certify that I have medically examined the above-mentioned person and his/her health justifies a life expectancy of at least 5 years from this date.
Please send the compeleted form to:
GRC 2082E (2014-07-001)