Annual Information Report (Form 4) "*" indicates required fields ANNUAL INFORMATION REPORT(To be completed by the Pension Plan Administrator) Due Date DD dash MM dash YYYY (No later than 6 months after a plan’s financial year-end)1. Registration Number* 2. Name of Pension Plan* Plan Type* Defined Benefit Defined Contribution Multi-employer Other (specify) 4. Plan Reporting Period Plan Administrator - Name and Mailing AddressContact* Title* Company Name* Address* City Postal/Zip Code Email Telephone Area Code Extension 6. Employer - Name and AddressName Address City Postal/Zip Code Telephone Area Code Extension *Please note that if a Financial Institution Pension Plan, please include a list of participating employers with individual member data7. Body Holding Pension Fund Assets - Name and AddressName Address City Postal/Zip Code Telephone Area Code Extension 8. Location of books or records maintained by the plan administrator or – same as plan administrator’s addressAddress City Postal/Zip Code 9. Name of collective bargaining agent representing the largest number of members of the pension plan, or not applicable 10. Funding information for the Reporting PeriodContributions made in respect of the reporting period:Employer contributions Member required contributions Additional voluntary contributions 11. Membership Information at the end of the Reporting PeriodIndicate number of plan members & former membersMale Female Total Number of plan members & former members 12. Annual Information Report Fee CalculationTotal plan members & former members Quantity* Price: $5.00 Quantity Total Total members x $5Fee payment must be the number shown above multiplied by $5.00 and Number of total members Payment can be made by online or by cheque payable to the Pension Commission or directly to the Commission’s bank account.Pay/Paid by* Wire Transfer / Cheque Credit/Debit Card Upload proof of paymentAccepted file types: pdf, jpg, png, doc, docx, Max. file size: 10 MB.Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name 13. Confirmation of CompliancePlan administrators are required to review the Statement of Investment Policies and Goals (SIP&G) at least once each year in order to confirm or amend it.Have you reviewed the SIP&G since the last Annual Information Report?* Yes No If yes, enter the date the SIP&G was last reviewed DD dash MM dash YYYY Have you amended the SIP&G since the last Annual Information Report?* Yes No If yes, enter the date of the last amendment DD dash MM dash YYYY Have the pension plan and fund been administered in compliance with the National Pension Scheme (Occupational Pensions) Act 1998* Yes No If no, please attach an explanationAttach explanationMax. file size: 10 MB.14. CertificationAs the authorized representative of the administrator of the above noted pension plan, I certify that all the information presented on this form is true to the best of my knowledge and belief.DATEDMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature of WitnessSignature of authorized representativeName of Witness (please print) Name of authorized representative (please print) Address of Witness Title/Position (please print) 15. Amounts transferred in from other plans 16. Payment of benefits from the plan 17. Transfers of benefits to other plans 18. Market value of assets at beginning of reporting period 19. Market value of assets at end of reporting period 20. Total expenses at end of reporting period 21. Net investment earnings (losses) 22. Did the pension plan terminate or become inactive prior to or in this reporting period?* Yes No If yes, enter Date of Termination DD dash MM dash YYYY Date of Final Distribution DD dash MM dash YYYY If all the assets were distributed pursuant to the termination of the plan, enter the date of final distribution. [No further questions]23. How many employers participated in the plan at the end of the reporting period?