Form No 7: Annual Administrative Fees "*" indicates required fields Due Date* DD slash MM slash YYYY (No later than 30 June of each applicable calendar year)Plan Reporting Year End* (All sections must be completed, as applicable)1: Registration/Reference number 2: Name of Pension Plan/Local Retirement Product 3: Plan AdministratorCompany Name Contact Email Telephone (Area code) 4: Administrative Fee Calculation (at plan’s or local retirement product’s year-end)Financial Institution Pension Plan Quantity Price: $30.00 Quantity Provide Number of Members/Former MembersLocal Retirement Product Quantity Price: $30.00 Quantity Provide Number of Members/Former MembersIndividual Plan self-administered by an employer Quantity Price: $30.00 Quantity Provide Number of Members/Former MembersMulti-Employer Plan (Hotel Pension Fund & Restaurant Pension Plan) Quantity Price: $30.00 Quantity Provide Number of Members/Former MembersIndividual Plan administered by a third party administrator Quantity Price: $30.00 Quantity Provide Number of Members/Former MembersTotal Payable Pay/Paid by* Wire Transfer/Cheque Credit/Debit Card Credit/Debit Card Information* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Upload proof of payment (if cheque or wire transfer)Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 20 MB.5: CertificationAs the authorized officer of the administrator of the above noted pension plan or local retirement product, I certify that all the information presented on this form is true to the best of my knowledge and belief.DATED* DD dash MM dash YYYY Signature of WitnessSignature of authorized signing officerName of Witness (please print) Name of authorized signing officer (please print) Address of Witness Title/Position (please print)
