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Forms: PSS

• Members' Forms
• Employers' Forms

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Members' Forms

These forms are for use by PSS members only.

• Application for Resignation or Dismissal Benefit (PSS Member Form 601 09/04)
  [ PDF Document]
• Application for Retirement Benefit (PSS Member Form 602 02/07)
  [ PDF Document]
• Election by Invalidity Pensioners to Commute (exchange) pension to a lump sum on 60th birthday (PSS Member Form 603 04/05)
  [ PDF Document]
• Directions for payment of an Invalidity Pension Benefit (PSS Member Form 604 05/04)
  [ PDF Document]
• Directions for payment of an invalidity lump sum benefit (PSS Member Form 605 05/05)
  [ PDF Document]
• Application for an invalidity benefit (PSS Member Form 606 05/05)
  [ PDF Document]
• Application for payment of a spouse or de facto partner pension benefit upon the death of a PSS pensioner (PSS member form 607 01/07)
  [ PDF Document]
• Commutation of Part Hurt on Duty Pension (PSS Member Form 608 05/05)
  [ PDF Document]
• Application for disengagement benefit (PSS Member Form 612 05/05)
  [ PDF Document]
• Privacy disclosure consent form for PSAC determined benefits (PSS Member Form 614 04/06)
  [ PDF Document]
• Application for payment of a spouse or de facto partner pension benefit upon the death of a PSS member (PSS Member Form 615 01/07)
  [ PDF Document]
• Election to commute PSS incapacity pension to lump sum (PSS Member Form 616 02/07)
  [ PDF Document]
• Application Form for Medical Discharge Benefit (PSS Member Form 11 12/07)
  [ PDF Document]
  Notes for Application form for Medical Discharge Benefit
  [ PDF Document]
  PSS Medical Report - Form 11
  [ PDF Document]
  Template for PSS Medical Report - Form 11
  [ MS Word Template]
• Application Form for Medical Discharge Benefit for a former member (PSS Member Form 12 12/07)
  [ PDF Document]
  Notes for Application form for Medical Discharge Benefit for a former member
  [ PDF Document]
  PSS Medical Report - Form 12
  [ PDF Document]
  Template for PSS Medical Report - Form 12
  [ MS Word Template]
• Application Form for an increase in a hurt on duty pension (PSS Member Form 14 12/07)
  [ PDF Document]
  Notes for Application form for an increase in a hurt on duty pension
  [ PDF Document]
  PSS Medical Report - Form 14
  [ PDF Document]
  Template for PSS Medical Report - Form 14
  [ MS Word Template]
  PSS Vocational Assessment Report - Form 14
  [ PDF Document]
  Template for PSS Vocational Assessment Report - Form 14
  [ MS Word Template]
• Application Form for Permanent Impairment Benefit (s.12D) (PSS Member Form 17 09/07)
  [ PDF Document]

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Employers' Forms

These forms are for use by employer representatives for PSS only.

• Advice of Member Ceasing Employment (PSS Employer Form 609 05/05)
  [ PDF Document]
• Advice of Full-time Ordinary LWOP (for more than 5 continuous days) (PSS Employer Form 610 06/05)
  [ PDF Document]
• Advice of Part-time LWOP (PSS Employer Form 611 06/05)
  [ PDF Document]

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See also: Forms for all schemes

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