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Pension Benefits Standards Regulations, 1985 (SOR/87-19)

Regulations are current to 2020-10-05 and last amended on 2017-06-23. Previous Versions

SCHEDULE IV

FORM 1(Subsection 23(2) and paragraph 23.2(a))Statement To Be Provided to a Retiring Member

Statement date blank line

Member’s name blank line Date of birth blank line

Spouse’s or common-law partner’s name blank line Date of birth blank line

Designated beneficiary blank line

Date employment began blank line

Date credited service began blank line

Date pensionable age reached blank line

Date of first entitlement to early retirement pension blank line

Credited service blank line

Additional voluntary contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of retirement $ blank line

Required contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of retirement $ blank line

Employer contributions, in respect of a defined contribution provision, if any,

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of retirement $ blank line

Transfers into the pension plan

  • (a) lump sum amounts $ blank line

  • (b) benefit attributable to such transfers $ blank line

  • (c) service credited to such transfers blank line

Pension benefit payable to the member

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit payable $ blank line

Pension benefit payable for a limited period

Survivor benefit $ blank line

Solvency ratio blank line

Formula, if any, for indexing the pension benefit blank line

FORM 2(Subsection 23(3))Statement To Be Provided if a Member Ceases To Be a Member of the Plan for Any Reason Other than the Termination of the Whole or Part of the Plan or Retirement

Statement date blank line

Member’s name blank line Date of birth blank line

Spouse’s or common-law partner’s name blank line Date of birth blank line

Designated beneficiary blank line

Date employment began blank line

Date credited service began blank line

Date pensionable age reached blank line

Date of first entitlement to early retirement pension blank line

Credited service blank line

Additional voluntary contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Required contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Employer contributions, in respect of a defined contribution provision, if any,

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Transfers into the pension plan

  • (a) lump sum amounts $ blank line

  • (b) benefit attributable to such transfers $ blank line

  • (c) service credited to such transfers blank line

Pension benefit payable to the member

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit payable $ blank line

Pension benefit payable for a limited period

Survivor benefit prior to retirement

  • (a) total benefit $ blank line

  • (b) group insurance offset $ blank line

  • (c) net benefit $ blank line

Pension benefit credit for transfer purposes

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit credit payable $ blank line

Solvency ratio blank line

Schedule of transfer payments (if solvency ratio is less than 1) blank line

Formula, if any, for indexing the pension benefit or for calculating the pension benefit credit blank line

Portability options available (transfer to another pension plan, a locked-in registered retirement savings plan, a life income fund or restricted life income fund, or purchase of an immediate or deferred life annuity) blank line

FORM 2.1(Subsection 23.4(1))Statement To Be Provided Within 30 Days After the Termination of the Whole of the Plan

Statement date blank line

Plan termination date blank line

Member’s or former member’s name blank line Date of birth blank line

Spouse’s or common-law partner’s name blank line Date of birth blank line

Designated beneficiary blank line

Each member, former member and the spouse or common-law partner of each member or former member may examine, at the plan administrator’s offices, or order photocopies of, on condition of payment of any reasonable fee that the administrator may fix, all documents that have been filed with the Superintendent under subsection 10(1) or 10.1(1) or section 12 of the Pension Benefits Standards Act, 1985 or any regulations made under paragraph 39(i) of that Act.

Pension benefits will continue to be paid to retirees as they fall due.

Other pension benefits cannot be distributed until the termination report is approved by the Superintendent.

FORM 2.2(Subsection 23.4(2))Statement To Be Provided Within 120 Days After the Termination of the Whole of the Plan

Statement date blank line

Member’s or former member’s name blank line Date of birth blank line

Spouse’s or common-law partner’s name blank line Date of birth blank line

Designated beneficiary blank line

Date employment began blank line

Date credited service began blank line

Date pensionable age reached blank line

Date of first entitlement to early retirement pension blank line

Credited service blank line

Additional voluntary contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Required contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Employer contributions, in respect of a defined contribution provision, if any,

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of cessation of membership $ blank line

Transfers into the pension plan

  • (a) lump sum amounts $ blank line

  • (b) benefit attributable to such transfers $ blank line

  • (c) service credited to such transfers blank line

Pension benefit payable to the member

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit payable $ blank line

Pension benefit payable for a limited period

Survivor benefit prior to retirement

  • (a) total benefit $ blank line

  • (b) group insurance offset $ blank line

  • (c) net benefit $ blank line

Pension benefit credit for transfer purposes

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit credit payable $ blank line

Solvency ratio blank line

Schedule of transfer payments (if solvency ratio is less than 1) blank line

Formula, if any, for indexing the pension benefit or for calculating the pension benefit credit blank line

Portability options available (transfer to another pension plan, a locked-in registered retirement savings plan, a life income fund or restricted life income fund, or purchase of an immediate or deferred life annuity) blank line

The member or former member must give notice of the transfer option that they have chosen.

A description of any adjustments to benefits and the reasons for these adjustments blank line

FORM 3(Subsection 23(4))Statement To Be Provided when a Member or Former Member Dies

Statement date blank line

Member’s or former member’s name blank line Date of birth blank line

Spouse’s or common-law partner’s name blank line Date of birth blank line

Designated beneficiary blank line

Date employment began blank line

Date credited service began blank line

Credited service blank line

Additional voluntary contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of member’s death $ blank line

Required contributions of member

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of member’s death $ blank line

Employer contributions, in respect of a defined contribution provision, if any,

  • (a) made during the plan year $ blank line

  • (b) accumulated to date of member’s death $ blank line

Transfers into the pension plan

  • (a) lump sum amounts $ blank line

  • (b) benefit attributable to such transfers $ blank line

  • (c) service credited to such transfers blank line

Pension benefit credit payable to the member’s or former member’s spouse or common-law partner

  • (a) attributable to the benefit formula $ blank line

  • (b) attributable to additional voluntary contributions $ blank line

  • (c) attributable to the “50% rule” $ blank line

  • (d) attributable to any other lump sum amount $ blank line

  • (e) total pension benefit or pension benefit credit payable $ blank line

Solvency ratio blank line

Schedule of transfer payments (if solvency ratio is less than 1) blank line

Formula, if any, for indexing benefit or for calculating the pension benefit credit blank line

Portability options available (transfer to another pension plan, a locked-in registered retirement savings plan, a life income fund or restricted life income fund, or purchase of an immediate or deferred life annuity) blank line

FORM 4

[Repealed, SOR/2015-60, s. 29]

FORM 5(Paragraph 23.2(a))Statement To Be Provided to a Member to Whom a Phased Retirement Benefit Is To Be Paid and to the Member’s Spouse or Common-Law Partner

Statement date blank line

Member’s name blank line

Date of birth blank line

Spouse’s or common-law partner’s name blank line

Date of birth blank line

Phased retirement benefit:

Phased retirement benefit payable, expressed as

(a) a percentage of the accrued pension benefit as of the date on which the agreement referred to in paragraph 16.1(3)(a) of the Act takes effect blank line%

(b) an annual amount $blank line

Frequency and terms of adjustment, if any, to the phased retirement benefit during the phased retirement period to reflect pension benefit accrued during that period blank line

Formula, if any, for indexing the phased retirement benefit blank line

Bridging benefit, payable from blank line to blank line, expressed as

(a) a percentage of the accrued pension benefit to date blank line%

(b) an annual amount $blank line

Pension benefit payable at retirement:

Formula for calculating the pension benefit payable at retirement blank line

Formula for determining the contributions payable during the phased retirement period and the pension benefit accrual during that period and, if applicable, the proportion of part-time service for which the member will be credited blank line

FORM 5.1(Paragraph 23.2(b))Statement To Be Provided to a Former Member to Whom a Phased Retirement Benefit Is To Be Paid and to the Former Member’s Spouse or Common-Law Partner

Statement date blank line

Former member’s name blank line

Date of birth blank line

Spouse’s or common-law partner’s name blank line

Date of birth blank line

Phased retirement benefit:

Phased retirement benefit payable, expressed as

(a) a percentage of the pension benefit being received prior to phased retirement period blank line%

(b) an annual amount $ blank line

Frequency and terms of adjustment, if any, to the phased retirement benefit during the phased retirement period to reflect pension benefit accrued during that period blank line

Formula, if any, for indexing the phased retirement benefit blank line

Bridging benefit, payable from blank line to blank line, expressed as

(a) a percentage of the accrued pension benefit to date blank line%

(b) an annual amount $ blank line

Pension benefit payable at retirement:

Formula for calculating the pension benefit payable at retirement blank line

Formula for determining the contributions payable during the phased retirement period and the pension benefit accrual during that period and, if applicable, the proportion of part-time service for which the member will be creditedblank line

NOTE: Under paragraph 16.1(4)(g) of the Pension Benefits Standards Act, 1985, if the former member is receiving an immediate pension benefit from a pension plan that provides for the payment of a phased retirement benefit, the administrator of that pension plan shall cease paying the immediate pension benefit when payment of a phased retirement benefit begins and an existing waiver of the joint and survivor pension benefit is void, except if the waiver was made under a court order or agreement relating to the distribution of property on divorce, annulment, separation or breakdown of a common-law partnership. When payment of an immediate pension benefit is to commence following the phased retirement period, a new election as to the form of that benefit may be made in accordance with subsection 22(5) of the Pension Benefits Standards Act, 1985.

FORM 5.2(Section 23.3)Spouse’s or Common-Law Partner’s Consent to the Election To Receive a Variable Benefit from a Defined Contribution Provision

I, blank line, hereby certify that I am the spouse or the common-law partner, as defined in the Pension Benefits Standards Act, 1985, of blank line.

I understand that my spouse or common-law partner has elected to receive a variable benefit directly from the pension plan, and that my written consent is required to enable my spouse or common-law partner to do so.

I understand that

(a) electing to receive a variable benefit directly from the pension plan will allow my spouse or common-law partner to manage his or her own pension fund and will allow some flexibility in determining the amount that will be paid as a variable benefit in each calendar year;

(b) the remaining funds may be used to purchase a life annuity at a later date, but there is no requirement that the remaining funds be used to purchase a life annuity;

(c) if the remaining funds are used to purchase a life annuity, the life annuity must be joint unless I waive my entitlements by signing a separate waiver form within 90 days before the day on which the annuity payments begin; and

(d) a variable benefit paid directly from the pension plan is not paid in the joint and survivor form.

I further understand that before purchasing a life annuity, the pension plan will allow my spouse or common-law partner to withdraw some of the funds each year, subject to minimum and maximum withdrawal limits. I understand, however, that the amount of pension income or survivor benefit available to me in later years may be significantly reduced if

(a) my spouse or common-law partner elects to withdraw the maximum amount permitted each year; or

(b) the investment performance is poor.

Nevertheless, I consent to the receipt of variable benefits directly from the pension plan, and certify that

(a) I have read this form and understand it;

(b) neither my spouse or common-law partner nor anyone else has put any pressure on me to sign this form;

(c) I realize that

(i) this form only gives a general description of the legal rights I have under the Pension Benefits Standards Act, 1985 and the Pension Benefits Standards Regulations, 1985, and

(ii) if I wish to understand exactly what my legal rights are I must read the Pension Benefits Standards Act, 1985 and the Pension Benefits Standards Regulations,1985 or seek legal advice; and

(d) I realize that I am entitled to a copy of this consent form.

To consent to the transfer, I sign this consent form at blank line on blank line, 20blank line.

Signature of spouse or common-law partner blank line

Address of spouse or common-law partner blank line

(home telephone number) blank line

(work telephone number) blank line

STATEMENT OF WITNESS

I certify that

(a) My full name is blank line

(b) My address is blank line

(c) I witnessed blank line sign this waiver.

(home telephone number) blank line

(work telephone number) blank line

FORM 6(Section 30.1)Consent of Spouse or Common-Law Partner to the Cessation of the Payment of the Joint and Survivor Pension Benefit

I, blank line, hereby certify that I am (a) the spouse or (b) the common-law partner, as defined in subsection 2(1) of the Pension Benefits Standards Act, 1985, of blank line, a retired former member of the pension plan known as blank line.

Under the terms of that pension plan

(a) the amount of the joint and survivor pension benefit payable to my spouse or common-law partner as a retired former member is $blank line per year; and

(b) the amount of the survivor benefit that would be payable to me on the death of my spouse or common-law partner is $blank line per year.

I understand that:

My consent to the cessation of the payment of the joint and survivor pension benefit described in paragraph (a) is required to allow the payment of a phased retirement benefit to my spouse or common-law partner.

By giving my consent, I am no longer entitled to the survivor benefit described in paragraph (b) that currently would be payable to me on the death of my spouse or common-law partner.

If my spouse or common-law partner dies while receiving a phased retirement benefit, the survivor benefit will be payable to the person who is at that time his or her spouse or common-law partner.

A new election as to the form of the immediate pension benefit that will commence after the phased retirement period may be made when that benefit commences, in accordance with subsection 22(5) of the Pension Benefits Standards Act, 1985.

Based on the above, and in accordance with paragraph 16.1(3)(b) of the Pension Benefits Standards Act, 1985, I hereby consent to the cessation of the payment of the joint and survivor pension benefit described in paragraph (a).

Signed at blank line on the blank line day of blank line, 20blank line

Name of spouse or common-law partner blank line

Signature of spouse or common-law partner blank line

Name of witness (other than the former member)blank line

Signature of witness blank line

  • SOR/2001-194, ss. 5, 6
  • SOR/2009-100, ss. 3, 4
  • SOR/2015-60, ss. 29, 30(F), 31
 
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