Payment Transmittal Form - Public Works And Government Services Canada Page 2

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FOR OFFICE USE ONLY
Form Number
Regimental Number
Pension Number
Carefully read instructions before completing.
This form is used by the plan member for the purpose of remitting payments in respect of a period of leave without
pay and/or a service buyback. This form provides information necessary for accounting purposes.
Send the completed form to the following address together with your payment:
Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
PO Box 8500
Matane QC G4W 0E2
Cash payments such as personal cheques and money orders must be made payable to the Receiver General for
Canada.
If sending a payment in respect of more than one service buyback, indicate the total of the monthly deduction
amount for all service buybacks.
If your payment is made through a direct transfer of funds from a Registered Retirement Savings Plan (RRSP),
complete and attach the Canada Revenue Agency form T2033 to this form (in lieu of a cheque or money order).
Note: In Part C of the form T2033 indicate "0355446" for the CRA registration number and "Royal Canadian Mounted
Police Superannuation Account" for the RPP name.
Payment Information
The payment is for:
Pension Contributions
Service Buyback Payment
u
Monthly Deduction Amount (required for service buyback only)
u
Amount of Payment
u
From
To
This payment covers the following period
RCMP-GRC 570E (2014-07-001)
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