UNCLASSIFIED

Application for Registration of a Pension Plan

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

002	Type of Pension Plan  

Defined Benefit (DB)   
Defined Contribution / Money Purchase (DC)
Combination 

003	Effective Date of Pension Plan		Day       Month      Year      

004	Pension Plan Year End		Day      Month       

005	Number of Employers 

a)	Single Employer pension plan

b)	Multi-employer pension plan

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

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

006	Plan Administrator 

	Indicate whether the plan administrator is:

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

	Plan administrator        
	
	Name of contact       

	Address        

	City         		

	Province/State/Country        

	Postal Code       	

	Telephone       		Fax        	

	E-mail        

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

	Name:	     					Phone:     
			e-mail      						

	Name:	     					Phone:     
			e-mail      						

	Name:	     					Phone:     
			e-mail      						

	Name:	     					Phone:     
			e-mail      						
	
	Name:	     					Phone:     
			e-mail      						

	Name:	     					Phone:     
			e-mail      						

008	Third Party Administrator (if applicable)

	Name of contact       

	Name of company       

	Address        

	City         		

	Province/State/Country        

	Postal Code       	

	Telephone       		Fax        	

	E-mail        

009	How is the Pension Fund Deposited?

	Single Insurance Company -	any type of account	Other – please describe		
	Single Trust Company - pooled funds							
	Single Trust Company - outside pooled funds						
	Pension Fund Society								

010	Pension Fund Custodian(s)

	Company     

	Policy/Account #      

	Contact       					

	Telephone      		E-mail	     	
	
				_______________________		__________________________

011	Does this pension plan result from a division/spin-off of an existing pension plan?	
		
	Yes	  No
	
	If yes, please provide the name and registration number of the existing pension plan.
	
	Pension Plan Name      

	OSFI Registration Number      

012	Was this pension plan previously registered with a province?		Yes	  No

	If yes,
	Province      

	Provincial Registration Number	     

013	Is this pension plan registered with the Canada Revenue Agency?	 Yes	No

	If yes, CRA Registration Number:      

014	DB pension plans only 

	Is the plan a designated plan under the Income Tax Act?			Yes	No

015	DB pension plans only

	Does the plan text provide for the use of surplus during the continuation of the 	plan and on its termination?						  Yes	  No

016	Was the pension plan established pursuant to a collective agreement?		

	  Yes   No 

If yes, 
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			     
017	Information to Members

Have all members and their spouses received a copy of the written explanation of the terms and conditions of the pension plan and of their rights and duties thereunder?	

Yes 			  No 

018	Nature of Business - Included Employment

	Describe the main activity or activities of the pension plan sponsor and indicate the appropriate category on the chart below:

	     

	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 
     Funding Agency if any   
										Other 	

019	Type of Organization
	
	Trade or Employee Association		Sole Proprietorship or Partnership	
				
	Crown Corporation		Co-operative or Non-Profit 	
				
	Incorporated Company		Other – please describe	
	 privately held     publicly traded

020	Are all members of the pension plan in included employment?	Yes	 No

021	Pension Plan Membership - as of the effective date of the pension plan.  
	
Area of Employment	(1) Male	(2) Female	(3) Included Employment	(4) Provincial Jurisdiction	(5) Total (3)+(4)	
Newfoundland				*		
Prince Edward Island						
Nova Scotia						
New Brunswick						
Quebec				*		
Ontario						
Manitoba						
Saskatchewan						
Alberta						
British Columbia						
Northwest Territories				N/A**		
Nunavut Territory				N/A**		
Yukon				N/A**		
Outside Canada						
Total						
	
* If the plan includes members under the jurisdiction of these provinces, the plan must also be registered in these provinces.  See Instruction Guide – Jurisdiction of Registration
** All employment in the Northwest Territories, the Yukon Territory or Nunavut is in included employment.  See Instruction Guide – Line 012 

022	Documents Attached
  		
All Plans
	
	Pension Plan Text or By-laws	
	Employee Booklet	
	Insurance Contract /  Trust Agreement (Individual Trustees or Corporate Trustee) or other custodial instrument	
	Amendments, if any,  to any of the accompanying documents	
DB or Combination Plans only
	
	Initial Valuation Report and Actuarial Information Summary (OSFI form T1200)	
	Reciprocal Transfer Agreement (if applicable)	
	Relevant Sections of Collective Agreement (if pension plan established pursuant to a collective agreement)	
DC Plans only
	
	Cost Certificate	

DECLARATION OF COMPLIANCE 

I, _____________________________________________________, DECLARE THAT, to the best of my knowledge, the information given herein and in all forms and documents relating to this application 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       , 200      , 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

OSFI Periodic Filing Requirements  

DB/Combination plans 

Form/Document Required	Filing Date	
Annual Information Return (OSFI 49) *
	Within 6 months of the pension plan year end.  Filing fee will be invoiced upon receipt of the Return.	
Certified Financial Statements(OSFI 60)* and Audit Report (if required)
	Annually within 6 months of the pension plan year end.	
Annual Solvency Information Return  
(OSFI 575) **
	Generally 45 days after the pension plan year end.	
Valuation Reports and/or cost certificates and Actuarial Information Summary (OSFI T1200)**
	Triennially if SR is above 1.
Annually if SR of the pension plan is below 1.
Must be filed within 6 months of the pension plan year end.	
Amendments to documents that create or support the pension plan or pension fund including the Declaration of Compliance (OSFI 522)** and the Addendum to the Declaration of Compliance(OSFI 521)**	Within 60 days after making such an amendment 

DC plans 

Form/Document Required	Filing Date	
Annual Information Return (OSFI 49)*
	Within 6 months of the pension plan year end. Filing fee will be invoiced upon receipt of the Return.	
Certified Financial Statements(OSFI 60)* and Audit Report (if required)
	Annually within 6 months of the pension plan year end	
Amendments to documents that create or support the pension plan or fund including the Declaration of Compliance (OSFI 522)** and the Addendum to the Declaration of Compliance (OSFI 521)**	Within 60 days after making an amendment 

* These OSFI forms are available electronically through our accepted software vendors.  See list of these on the OSFI Web site http://www.osfi-bsif.gc.ca/osfi/index_e.aspx?ArticleID=216.

** These OSFI forms are available on the OSFI Website above.