Application for Registration of a Pension Plan



UNCLASSIFIED

(Draft) OSFI-48DC - Application for Registration of a

Defined Contribution Pension Plan

(Please refer to the Instruction Guide for the Application for Registration of a Defined Contribution Pension Plan while completing this form.)

PART I

Line

001 Official Name of the Pension Plan (the Plan):      

002 Effective Date of the Plan: Year       Month       Day      

003 Pension Plan Year End: Month       Day      

004 Number of Participating Employers

a) Single Employer plan Name of Employer      

b) Multi-employer plan

c) More than one participating employer but not a multi-employer plan

d) Simplified pension plan

If b) or c) or d), please list or attach a list of all participating employers. If c) please indicate the principal employer.

________________________________________________________________________

005 Name of Plan Administrator

Plan Administrator__________________________________________________

(If the administrator is a corporation, pension committee or board, use the name of the corporation, committee or board)

Primary Plan contact      

(The primary plan contact is, for example, the Chair of the pension committee or board. The contact person here is not the same as the 3rd party administrator.)

Address      

City       Province/State/Country      

Postal Code      

Telephone       Fax       E-mail      

006 Indicate whether the Plan Administrator is:

Employer(s) Board of Trustees Pension Committee or similar body

Insurance Company (only applies to Simplified Pension Plans)

If administered by a Board of Trustees/Pension Committee please list or attach a list of all names and contact information.

|Name:       |Phone       |

|e-mail       |Fax       |

|Name:       |Phone       |

|e-mail       |Fax       |

007 Third party administrator (if applicable)

Name of contact      

Name of company      

Address       City      

Province/State/Country       Postal Code      

Telephone       Fax       E-mail      

008 How is the pension fund deposited? (check all that apply)

Insurance company contract - Fully guaranteed

Insurance company contract - Not fully guaranteed

Pension Fund Society

Single Trust Company - pooled funds

Single Trust Company – outside pooled funds

Trust Agreement (please provide names and addresses of Trustees)

Other – provide details _____________________________________

009 Name of Pension Fund Custodian (if more than one, please attach a list with the following information)

Company Name     

Address      

Policy/Account #      

Contact Name      

Telephone       E-mail       Fax:     

010 Does the Pension Plan (for which this Application is being filed) result from a

division/spin-off/termination of another plan?

Yes No

011 If “Yes”, please complete the following regarding the “other plan”:

Jurisdiction      

Pension Plan Name      

OSFI/Provincial Registration Number       and

Canada Revenue Agency Registration Number      

Will the other plan be terminated? Yes No

Will assets be transferred to this new plan? Yes No

012 Have you applied to register this plan with the Canada Revenue Agency? Yes No

If registered, please provide the CRA Registration Number:      

013 Is the pension plan established pursuant to a collective agreement? Yes No

If “Yes”, please attach a copy of the relevant sections of the collective agreement.

Is the pension plan contribution level set by the collective agreement?

Yes No

Expiration date of current collective agreement      

Collective bargaining agent/union(s) representing the pension plan members      

014 Information to Members

Have all eligible employees, their spouses or common-law partners received a written explanation of the terms and conditions of the pension plan and been informed of their rights and duties thereunder? Yes No If “No”, please explain      

015 Nature of Business - Included Employment (Refer to Guide for further details)

Describe the main activity or activities of the pension plan sponsor      

Indicate the appropriate category on the chart below (select only one):

| |Navigation and Shipping | |Chartered Bank |

| | | | |

| |Harbour Operations | |Flour, Feed or Seed Mill |

| | | | |

| |Rail Transportation | |Atomic Energy |

| | | | |

| |Air Transportation | |Uranium Mining |

| | | | |

| |Road Transportation | |N.W.T., Nunavut and/or Yukon |

| | | | |

| |Radio and/or Television | |Interprovincial Pipelines |

| | | | |

| |Telephone and Other Communication | |International Bridge |

| | | | |

| |First Nations[1] | |Other – please describe |

| | | |      |

| |Funding Agency if any       | | |

| |created through Band or Treaty | | |

| |created as separate entity/incorporation | | |

016 Type of Organization

| |Trade or Employee Association | |Sole Proprietorship or Partnership |

| | | | |

| |Crown Corporation | |Co-operative or Non-Profit |

| |Agent | | |

| | | | |

| |Incorporated Company: | |Other – please describe |

| |privately held publicly traded | |      |

| | | | |

017 Pension Plan Membership - as of the effective date of the Pension Plan.

| |

|Location of Employment |Male |Female | |Included Employment 003 |

| |001 |002 | | |

| | | | | |

|Newfoundland……. | | | | |

| | | | | |

| | | | | |

|Prince Edward Island ………. | | | | |

| | | | | |

|Nova Scotia ………………… | | | | |

| | | | | |

|New Brunswick …………….. | | | | |

| | | | | |

|Quebec …………………....... | | | | |

| | | | | |

|Ontario ………………........... | | | | |

| | | | | |

|Manitoba …………………… | | | | |

| | | | | |

|Saskatchewan ………………. | | | | |

| | | | | |

|Alberta ……………………… | | | | |

| | | | | |

|British Columbia….………… | | | | |

| | | | | |

|Yukon Territory ….…………. | | | | |

| | | | | |

|Northwest Territories……..…. | | | | |

| | | | | |

|Nunavut ………….……….…. | | | | |

| | | | | |

|Outside Canada ………..…….. | | | | |

| | | | | |

|Total Male/Female/Included Employment ………………..... | | | | |

| | | |

|Total Membership | | |

|(sum of cols. 001 and 002) | | |

|Other Beneficiaries | | |

|Grand Total | | |

PART II: Information concerning pension plan provisions

001. Eligibility – Class(es) of Employees (multiple entries acceptable, except if “All employees” has been checked).

Plan text reference:      

All employees Salaried Hourly Union Non-union

Supervisory Executives (including connected persons/specified individuals)

Other (describe)___________________________________________________

002. Eligibility for membership - new employees

Plan text reference:      

Compulsory membership

Voluntary membership

Closed to new members

Other (describe)________________________________________________

003. Employee contribution rate – current service

Plan text reference:      

No contributions required

________% of earnings (not integrated with CPP/QPP))

_________% of earnings less the required CPP/QPP contributions

________% of earnings up to YMPE or on which contributions to C/QPP are required and ________% on balance of earnings

$_______.__ per year

________ cents per hour.

Up to 18% of earnings (together with employer contributions),

Variable (describe) ______________________________________________

Other (describe) ________________________________________________

004. Employee additional voluntary contributions permitted?

Please provide section of plan text     

Yes No

005. Employer contribution rate –current service

Plan text reference:      

_____.____ % of earnings (not integrated)

____._____ % of earning less the required CPP/QPP contributions

____._____ % of earnings up to YMPE or on which contributions to CPP/QPP are required and ____.____ % on balance of earnings

$________ per year

_________ cents per hour

Based on employer profits with minimum of ____.____% of employee’s earnings

Up to 18% of earnings (together with employee contributions, if any)

Variable (describe) ____________________________________________

Other (describe) ______________________________________________

006. Investments Decisions

Please indicate who makes the investment decisions:

|All assets |Employer Contribution Only |Member Contribution Only |

| Employer | Employer | Employer |

|Member |Member |Member |

| | | |

007. Will variable benefits be paid from the pension fund as provided in section 16.2 of the PBSA?

Yes No

If “Yes”, provide Plan text reference:      

PART III

001. Required Documents Attached

| | |

| |Pension Plan Text or By-laws |

| |Employee Booklet |

| |Insurance Contract / Trust Agreement (Individual Trustees or Corporate Trustee) or other custodial instrument |

| |Collective Agreement (if pension plan established pursuant to a collective agreement) |

| |Amendments, if any, to any of the accompanying documents |

| |Cost Certificate |

| | |

002. Assessment

| | |

| |Assessment enclosed |

| | |

| | |

| | |

| | |

| | |

PART IV

DECLARATION OF COMPLIANCE

I,       , DECLARE THAT, to the best of my knowledge, the following is true and correct:

1. I am a duly authorized signing officer of the employer or a member of a board of trustees or similar body or pension committee that is the administrator of the (name of pension plan       ) hereinafter referred to as “the Plan”; and I hereby apply for registration for the Plan under the Pension Benefits Standards Act, 1985

2. The Plan, including all documents that create or support the Plan or the pension fund, complies with the Pension Benefits Standards Act, 1985, and the Regulations thereto. If the Plan includes members who are not employed in included employment and their benefits are subject to provincial pension legislation, the benefits of those members under the terms of the Plan, including all documents that create or support the Plan or the pension fund, complies with the provisions of the pension legislation of those other jurisdictions; and

3. A Statement of Investment Policies and Procedures was established for the Plan and adopted on       and this Statement of Investment Policies and Procedures complies with the requirements of the Pension Benefits Standards Act, 1985, and the Regulations thereto.

Signed this       day of       , 20      , in the City of       in the Province/State of      

Authorized officer of Plan Administrator Signature

(USE BLOCK LETTERS)

Title or Position

Would you prefer future correspondence in: English French

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[1] This does not include private enterprises such as a manufacturing facility

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