Contents
Short Title
Interpretation
2#
Payments for Elective Service
3#
4#
Unpaid Instalments
5#
6#
7#
Medical Examinations
Forms
11#
Schedule I · The Lieutenant Governors Superannuation Act (Section 11)
Election to Contribute for Prior ServiceTo the President of the Treasury Board, OTTAWAI (full name) of in the Province of 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 serviceor☐ for part only of such prior service, that is most recent in point of time, as herein specified.years and days or dates from/toI further elect to make contributions for such prior service in the following manner:☐ lump sumand/or☐ monthly instalments of $ deducted from my salary payments.Signed at this day of , 19 .WitnessSignature of Lieutenant Governor
Schedule II · The Lieutenant Governors Superannuation Act (Section 12)
Election not to ContributeTo the President of the Treasury Board, OTTAWAI (full name) of in the Province of 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 this day of , 19 .WitnessSignature of Lieutenant Governor
Federal laws of Canada reproduced under the Reproduction of Federal Law Order (SI/97-5); not the official version. Source: Justice Laws Website.