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Lieutenant Governors Superannuation Regulations (C.R.C., c. 1022)

Regulations are current to 2023-09-13

SCHEDULE I(Section 11)The Lieutenant Governors Superannuation Act

Election to Contribute for Prior Service

To the President of the Treasury Board, OTTAWA

I (full name) of blank line

in the Province of blank line hereby elect, under subsection 5(1) of the Lieutenant Governors Superannuation Act to contribute in respect of my period of prior service as the lieutenant governor of a province as follows:

    for the full period of such prior service


      for part only of such prior service, that is most recent in point of time, as herein specified.

years and days or dates from/to

I further elect to make contributions for such prior service in the following manner:

    lump sum


      monthly instalments of $ blank line deducted from my salary payments.

Signed at blank line this day of blank line, 19 blank line.

Witnessblank lineSignature of Lieutenant Governor

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