Wind Up Report for DB Pension Plans "*" indicates required fields PLAN INFORMATION1. Registration Number:* 2. Name of Pension Plan:* 3. Employer/Plan Sponsor:* 4. Pension Fund Holder(s):* 5. Collective Bargaining Agent:* WIND UP INFORMATION6. Type of wind up:* Full Partial Identify partial wind up group (if applicable) Identify partial wind up group (if applicable)7. Effective date of wind up:* Day Month Year Effective date of wind up complies with s. 38 (4):* Yes No 9. Month for which last contributions were received:* Day Month Year 10. All employee and employer contributions remitted to the fund to the effective date of wind up:* Yes No 11. Date last notice given to Members:* Day Month Year 12. Notice content and distribution complies with ss. 38 (2) (3) & ss. 1 – 4 of regulation 17:* Yes No N/A 13. Financial Information (as at Date of Application): Full Plan Assets (Market Value) Liabilities Surplus Please provide an explanation of how a surplus was created, the proposed treatment of the surplus and the allocation method, if applicable.14. Financial Information (as at Date of Application): Portion affected by wind up Assets (Market Value) Liabilities Surplus [Please provide an explanation of how a surplus was created, the proposed treatment of the surplus and the allocation method, if applicable.]15. Legislative Requirements – The following requirements have been applied: Full Vesting Benefits locked-in 16. Filing Requirements (full wind up only):All outstanding Annual Information Reports, Associated Fees and Financial Statements have been filed: Yes No RECOMMENDED FOR WIND-UP:* Yes No Pension Analyst (sign off) EXPLANATIONS & DECLARATIONS: (Include reference to section number):CERTIFICATION OF COMPLIANCE:I declare that:a) I have reviewed this report* a) I have reviewed this report b) the information contained in this wind up report is true and accurate and this report is complete,* b) the information contained in this wind up report is true and accurate and this report is complete, c) the benefits and options have been determined in accordance with the terms of the Pension Plan and meet the minimum requirements of the National Pension Scheme (Occupational Pensions) Act 1998, and,* c) the benefits and options have been determined in accordance with the terms of the Pension Plan and meet the minimum requirements of the National Pension Scheme (Occupational Pensions) Act 1998, and, d) to the best of my knowledge and belief, this report complies with the requirements of the National Pension Scheme (Occupational Pensions) Act 1998, except as noted in this report.* d) to the best of my knowledge and belief, this report complies with the requirements of the National Pension Scheme (Occupational Pensions) Act 1998, except as noted in this report. DATED this* Day Month Year Signature of administrator or authorized signing officerName of administrator of authorized signing officer Title/Position Name & Address of OrganizationTelephone Number Email*