Government of Canada / Gouvernement du Canada
Symbol of the Government of Canada


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

Regulations are current to 2023-09-13

SCHEDULE II(Section 12)The Lieutenant Governors Superannuation Act

Election not to Contribute

To the President of the Treasury Board, OTTAWA

I (full name) of blank line

in the Province of blank line hereby elect, under subsection 9(1) of the Lieutenant Governors Superannuation Act not to contribute under the Act.

I understand, thereby, that I am not entitled to any benefits under the Lieutenant Governors Superannuation Act other than a return of contributions made pursuant to sections 4, 5 or 13 of that Act, without interest.

I understand, further, that this election is irrevocable.

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

Witnessblank lineSignature of Lieutenant Governor

Date modified: