Trustee Application Form "*" indicates required fields Provide the name of the trustee and the following informationName* (Note: If the trustee is a company, use the name of the company)Email* Primary Contact* Telephone Number* (ext) Mailing Address* Postal Code* Indicate whether the trustee is (check the most appropriate)* a licensed trust company an individual another company other Please provide details If selected Another company or Other If the trustee is an individual, indicate if a representative of: the employer or employers or any other person required to make contributions members or former members a union other (please advise details) If selected Other, please advise details here INFORMATION CONCERNING THE PENSION PLANWhat is the name of the pension plan? ** What is the name of the pension plan? multi-employer defined benefit defined contribution other (provide details) if other, provide details OTHER PENSION PLANSDoes the applicant act (or has the applicant acted previously) as a trustee for any other pension plans? Yes No If "yes", provide the name of the previous plan(s) including the registration or reference number(s) (if applicable): The following documents are required (as applicable) for each type of trustee and must be submitted with this Form completed personal questionnaire completed corporate questionnaire Completed personal questionnaire*Accepted file types: jpg, png, pdf, docx, doc, Max. file size: 20 MB.Completed corporate questionnaire*Accepted file types: jpg, png, pdf, docx, doc, Max. file size: 20 MB.Application Fees: $100* Wire Transfer Credit/Debit Card Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name UploadMax. file size: 20 MB.Payment can be made by cheque payable to the Pension Commission or directly to the Commission’s bank account. Please upload proof of payment.AmountPlease note that if the applicant is approved, an additional fee of $100 fee is payable to the Commission to issue the certificate of approval.DECLARATIONI,* (please print), hereby apply for approval as a trustee of the Pension Plan identified in this Form in accordance with the Act and the Regulations. I make the application in connection with(Name of the pension plan)* Attach certified copies of the documents that support this application and required to be submitted under the Act and the Regulations. Drop files here or Select files Accepted file types: pdf, jpg, doc, docx, Max. file size: 768 MB. I DECLARE THATComply* The information provided in this Form and documents submitted with this application comply with the Act and the Regulations; Obligcation* I understand that the obligation to ensure that the information submitted in this Form and documents required to be submitted that comply with the Act and the Regulations is my responsibility and I declare that I have fulfilled that obligation and have complied with the provisions of the Act and the Regulations in making this application for approval. Documents* I am aware of my obligations under the Act and that the contents of this Form and the documents submitted with this Form, and my declarations are true to the best of my knowledge and belief. DATE* DD dash MM dash YYYY Signature of WitnessSignature of applicant or authorized signing officer of applicantName of Witness (printed)* Name of applicant or authorized signing officer of applicant
