Application For Division of a Royal Canadian Mounted Police Superannuation Act Pension Benefits in Accordance with the Pension Benefits Division Act PDF, 809KB)
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.
I hereby apply for the division of the pension benefits accrued to the plan member named herein under the
Royal Canadian Mounted Police Superannuation Act in accordance with the
Pension Benefits Division Act.
The completed application and supporting documents are to be returned to:
Every person who knowingly makes a false or misleading representation in any application or other proceeding under the Pension Benefits Division Act is guilty of an offence punishable on summary conviction.
GRC 2486E (2014-07-001)