Contents
- Her Excellency the Governor General in Council, on the rec…
- Short Title
- Interpretation
- Designated Provinces
- Excepted Employment
- Choice of Pension Committee and Pension Council Representative
- Investments
- Member Choice Accounts
- Funding
- Letters of Credit
- Crown Corporations
- Void Amendment
- Distressed Pension Plan Workout Scheme
- Funding and Governance Policies
- Application for Registration
- Reporting
- Refund of Surplus
- Arbitration Relating to Refund of Surplus
- Indexation
- Portability of Pension Benefit Credits
- Variable Benefit
- Information to Be Provided
- Information to Be Provided — Phased Retirement Benefits
- Information To Be Provided — Variable Benefits
- Information on Plan Termination
- Report on Termination of Plan
- Electronic Communications
- General
- Forms
- Schedule I Employment Excepted from Included Employment (Section 4)
- Schedule II [Repealed, SOR/95-171, s. 6] 1 Name, address and telephone…
- Schedule III Permitted Investments (Section 6)
- Schedule IV Statement date Member’s name Date of birth Spouse’s or com…
- Schedule V (Sections 20, 20.1, 20.2 and 20.3)
- Schedule VI (Section 10.2)
- Related provisions
- Amendments not in force
Her Excellency the Governor General in Council, on the recommendation of the Minister of Finance, pursuant to subsections 4(6) and 9(6) and section 39 of the Pension Benefits Standards Act, 1985, is pleased hereby to make the annexed Regulations respecting pension benefits standards, effective January 1, 1987.note
Short Title
1#
Interpretation
2#
Designated Provinces
3#
Excepted Employment
Choice of Pension Committee and Pension Council Representative
5#
Investments
6#
7.1#
Member Choice Accounts
7.3#
Funding
8#
9#
Letters of Credit
9.1#
Crown Corporations
9.2#
Void Amendment
9.3#
10#
Distressed Pension Plan Workout Scheme
Election
10.2#
10.3#
Information to be Provided to Members and Beneficiaries
10.4#
End of Negotiation Period
10.6#
Appointment of Representatives
10.7#
10.8#
Information to be Provided to Representatives
10.9#
Disclosure Requirements — Proposed Workout Agreement
10.91#
Consent of Members and Beneficiaries
Request for Approval
10.94#
Ministerial Considerations
Notification of Minister’s Decision
Minimum Requirements for Funding Schedule
10.97#
Optional Requirements for Funding Schedule
10.98#
Occurrence of Events After Approval of a Funding Schedule
10.99#
10.991#
Funding and Governance Policies
10.992Funding policy#
10.993Governance policy#
Application for Registration
11#
Reporting
13#
14#
15#
Refund of Surplus
16#
16.1#
Arbitration Relating to Refund of Surplus
16.2#
Indexation
17#
Portability of Pension Benefit Credits
18#
19#
19.1#
20#
20.1#
20.2#
20.3#
21#
Variable Benefit
21.1#
Information to Be Provided
22#
22.1#
23#
23.1#
Information to Be Provided — Phased Retirement Benefits
23.2#
Information To Be Provided — Variable Benefits
Information on Plan Termination
Report on Termination of Plan
24#
24.1#
Electronic Communications
25#
25.1#
25.2#
25.3#
General
26#
27#
28.2#
28.3#
28.4#
28.5#
Forms
30.1#
31#
Schedule I · Employment Excepted from Included Employment (Section 4)
1#
2#
Schedule II
[Repealed, SOR/95-171, s. 6]1 Name, address and telephone number of the administrator.2 Name and address of the pension fund custodian or trustee together with any applicable policy or account number.3 Name and address of the external auditor.4 Total membership in the plan at plan year end.5 List of all members of a board of trustees or pension committee of the plan.1 Are all of the benefits provided by an insured plan or by a pension plan in respect of which an annuity contract has been issued by the Government of Canada? Yes No2 Are all of the pension plan’s assets held in an unallocated general fund of a person authorized to carry on a life insurance business in Canada? Yes No(If the answer to Question 1 and 2 is “No”, complete the following.)3 As at the end of the last plan year, had the administrator established a written statement of investment policies and procedures in accordance with subsection 7.1(1) to the Pension Benefits Standards Regulations, 1985? Yes No4 If a statement of investment policies and procedures had been established as at the end of the plan year preceding the last plan year, did the administrator review it during the last plan year? Yes No5 If a statement of investment policies and procedures had been established as at the end of the plan year preceding the last plan year, was the statement amended during the last plan year? Yes No6 If a statement of investment policies and procedures was established or amended during the last plan year, were the pension council, if one exists, and the actuary to the plan, if the pension plan is a defined benefit plan, given a copy of the statement or amendments in accordance with subsection 7.1(3) or 7.2(2) of the Pension Benefits Standards Regulations, 1985? Yes No7 During the last plan year, were the moneys of the pension fund invested in accordance with section 6 of the Pension Benefits Standards Regulations, 1985? Yes NoCertificationI hereby certify that, to the best of my knowledge and belief, the information entered on this Investment Information Return, and any other information that has been requested by the Superintendent of Financial Institutions and is attached to this Return, is true and correct.Administrator’s SignatureName(s) (Use block letters)(If the administrator is a board of trustees or other similar body, all trustees or members of the body must sign)Date: 1 ApplicantI, , am a (member, former member, survivor) of the registered pension plan known as and I apply to2 Transfer or Purchase (check one)(a) transfer my pension benefit credit to a locked-in registered retirement savings plan of the kind described in section 20 of the Pension Benefits Standards Regulations, 1985;(b) transfer my pension benefit credit to a life income fund of the kind described in section 20.1 of the Pension Benefits Standards Regulations, 1985;(c) transfer my pension benefit credit to a restricted life income fund of the kind described in section 20.3 of the Pension Benefits Standards Regulations, 1985;(d) use my pension benefit credit to purchase an immediate life annuity of the kind described in section 21 of the Pension Benefits Standards Regulations, 1985;(e) use my pension benefit credit to purchase a deferred life annuity of the kind described in section 21 of the Pension Benefits Standards Regulations, 1985;(f) transfer my pension benefit credit to a pension plan of which I am currently a member, which is known as ; or(g) transfer my pension benefit credit to a PRPP.3 SignaturesSignature of member (or former member or survivor) Name of member (or former member or survivor) Signature of witness Name of witness Address of witness Signed at on , 20.4 Confirmation of the request received by the financial institution for (check one)(a) a transfer of the funds to a locked-in registered retirement savings plan of the kind described in section 20 of the Pension Benefits Standards Regulations, 1985;(b) a transfer of the funds to a life income fund of the kind described in section 20.1 of the Pension Benefits Standards Regulations, 1985;(c) a transfer of the funds to a restricted life income fund of the kind described in section 20.3 of the Pension Benefits Standards Regulations, 1985;(d) the use of the funds to purchase a deferred life annuity of the kind described in section 21 of the Pension Benefits Standards Regulations, 1985; or(e) the use of the funds to purchase an immediate life annuity of the kind described in section 21 of the Pension Benefits Standards Regulations, 1985, the funds of which shall be only used to purchase another immediate life annuity that meets the requirements of those Regulations.5 SignaturesSignature of applicant Name of applicant Signature of officer of financial institution Name of financial institution Signed at on , 20.I, , hereby certify that I am the spouse or common-law partner as defined by the Pension Benefits Standards Act, 1985, of .I understand that my spouse or common-law partner has elected to transfer their pension benefit credit and that my written consent is required to enable my spouse or common-law partner to do so.I understand that(a) transferring the pension benefit credit will allow my spouse or common-law partner to manage their own pension fund and will allow flexibility in determining the amount that will be paid to my spouse or common-law partner in each calendar year;(b) the transferred funds may be used to purchase a life annuity at a later date, but there is no requirement that the funds be used to purchase a life annuity;(c) if the transferred funds are used to purchase a life annuity, the life annuity must be in the joint and survivor form unless I waive my entitlements by signing a separate waiver form within 90 days before the day on which the annuity payments begin.I further understand that transferring the pension benefit credit to a retirement savings plan of the prescribed kind will allow my spouse or common-law partner to withdraw some of the funds each year, subject to any 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 transfer of the pension benefit credit to a retirement savings plan of the prescribed kind 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 keep a copy of this consent form.To consent to the transfer, I sign this consent form at on , 20.Name and registration number of pension plan of my spouse or common-law partner Signature of spouse or common-law partner Address of spouse or common-law partner (home telephone number) (work telephone number) STATEMENT OF WITNESSI certify that(a) My full name is (b) My address is (c) I witnessed sign this waiver.Signature of witness (home telephone number) (work telephone number) I, , hereby certify that I, am (a) the spouse or (b) the common-law partner, as defined in section 2 of the Pension Benefits Standards Act, 1985 of , a (member) (former member) of the pension plan known as .Under the terms of that pension plan,(a) the amount of pension benefit payable to my spouse or common-law partner as a (member) (former member) is $ per (period), and(b) the amount of the pension benefit payable to me on the death of my spouse or common-law partner is $ per (period), this amount being not less than 60 per cent of the pension benefit payable to my spouse or common-law partner in accordance with subsection 22(2) of the Pension Benefits Standards Act, 1985.Based on the above, and in accordance with subsection 22(5) of the Pension Benefits Standards Act, 1985, I hereby agree to waive: | | Check one1 | my entitlement to any pension benefit payable to me on the death of my spouse or common-law partner, or | 2 | a portion of the pension benefit payable to me on the death of my spouse or common-law partner so that my pension benefit is $ per (period), this amount being less than the minimum 60 per cent of the pension benefit payable to my spouse or common-law partner to which I would otherwise be entitled | Signed at on the day of , 19Signature of Witness (other than the member or former member) | Signature of Spouse or common-law partnerName of Witness | Address of Spouse or common-law partnerAddress of WitnessTo: | The Superintendent of Financial Institutions, Ottawa.Name of AdministratorMailing Address in CanadaPursuant to section 32 of the Pension Benefits Standards Act, 1985, notice of objection is hereby given to the action of the Superintendent of Financial Institutions in (refusing registration) (revoking registration and cancelling the certificate of registration) of the pension plan known asas evidenced by the Superintendent’s notification dated the day of , 19.The reasons for objection and the facts relevant thereto are as follows: | SignatureDate | Title or PositionNOTE:1 | This form is for the use of an administrator who, pursuant to section 32(1) of the Act, wishes to make a formal objection to the action of the Superintendent of Financial Institutions in refusing registration or revoking the registration and cancelling the certificate of registration of a pension plan.2 | TWO copies of the objection are to be sent by REGISTERED MAIL to the Superintendent of Financial Institutions, Office of the Superintendent of Financial Institutions, Ottawa, K1A 0H2, Canada. For the notice of objection to have effect, the envelope containing the objection must be postmarked within 60 days after the date that the Superintendent of Financial Institutions mailed the notification that registration had been refused or that registration had been revoked and the certificate of registration cancelled, as the case may be.3 | The NOTICE OF OBJECTION must be signed by the administrator.In Re the Pension Benefits Standards Act, 1985BETWEENAppellant-and-RespondentNOTICE OF APPEALNOTICE OF APPEAL is hereby given from the decision of the Superintendent of Financial Institutions to (refuse) (revoke) registration of the pension plan known asas evidenced by the notifications of the Superintendent dated the day of , 19, and the day of , 19.AStatement of Facts(Insert a brief statement of the facts, including the date and a brief résumé of the particulars of the application for registration or the circumstances surrounding the revocation of the registration of the pension plan.)BThe statutory provisions upon which the Appellant relies and the Reasons that the Appellant intends to submit:CName and Address of Appellant’s Solicitor (if any):Dated at this day of , 19 .(Appellant)
Schedule III · Permitted Investments (Section 6)
1#
2#
3#
8#
9#
11#
12#
13#
14#
15#
16#
17#
17.1#
18#
Schedule IV
Statement date Member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Designated beneficiary Date employment began Date credited service began Date pensionable age reached Date of first entitlement to early retirement pension Credited service Additional voluntary contributions of member(a) made during the plan year $ (b) accumulated to date of retirement $ Required contributions of member(a) made during the plan year $ (b) accumulated to date of retirement $ Employer contributions, in respect of a defined contribution provision, if any,(a) made during the plan year $ (b) accumulated to date of retirement $ Transfers into the pension plan(a) lump sum amounts $ (b) benefit attributable to such transfers $ (c) service credited to such transfers Pension benefit payable to the member(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit payable $ Pension benefit payable for a limited period(a) amount $ (b) from to Survivor benefit $ Solvency ratio Formula, if any, for indexing the pension benefit Statement date Member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Designated beneficiary Date employment began Date credited service began Date pensionable age reached Date of first entitlement to early retirement pension Credited service Additional voluntary contributions of member(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Required contributions of member(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Employer contributions, in respect of a defined contribution provision, if any,(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Transfers into the pension plan(a) lump sum amounts $ (b) benefit attributable to such transfers $ (c) service credited to such transfers Pension benefit payable to the member(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit payable $ Pension benefit payable for a limited period(a) amount $ (b) from to Survivor benefit prior to retirement(a) total benefit $ (b) group insurance offset $ (c) net benefit $ Pension benefit credit for transfer purposes(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit credit payable $ Solvency ratio Schedule of transfer payments (if solvency ratio is less than 1) Formula, if any, for indexing the pension benefit or for calculating the pension benefit credit 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) Statement date Plan termination date Member’s or former member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Designated beneficiary 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.Statement date Member’s or former member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Designated beneficiary Date employment began Date credited service began Date pensionable age reached Date of first entitlement to early retirement pension Credited service Additional voluntary contributions of member(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Required contributions of member(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Employer contributions, in respect of a defined contribution provision, if any,(a) made during the plan year $ (b) accumulated to date of cessation of membership $ Transfers into the pension plan(a) lump sum amounts $ (b) benefit attributable to such transfers $ (c) service credited to such transfers Pension benefit payable to the member(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit payable $ Pension benefit payable for a limited period(a) amount $ (b) from to Survivor benefit prior to retirement(a) total benefit $ (b) group insurance offset $ (c) net benefit $ Pension benefit credit for transfer purposes(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit credit payable $ Solvency ratio Schedule of transfer payments (if solvency ratio is less than 1) Formula, if any, for indexing the pension benefit or for calculating the pension benefit credit 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) 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 Statement date Member’s or former member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Designated beneficiary Date employment began Date credited service began Credited service Additional voluntary contributions of member(a) made during the plan year $ (b) accumulated to date of member’s death $ Required contributions of member(a) made during the plan year $ (b) accumulated to date of member’s death $ Employer contributions, in respect of a defined contribution provision, if any,(a) made during the plan year $ (b) accumulated to date of member’s death $ Transfers into the pension plan(a) lump sum amounts $ (b) benefit attributable to such transfers $ (c) service credited to such transfers Pension benefit credit payable to the member’s or former member’s spouse or common-law partner(a) attributable to the benefit formula $ (b) attributable to additional voluntary contributions $ (c) attributable to the “50% rule” $ (d) attributable to any other lump sum amount $ (e) total pension benefit or pension benefit credit payable $ Solvency ratio Schedule of transfer payments (if solvency ratio is less than 1) Formula, if any, for indexing benefit or for calculating the pension benefit credit 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) [Repealed, SOR/2015-60, s. 29]Statement date Member’s name Date of birth Spouse’s or common-law partner’s name Date of birth 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 %(b) an annual amount $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 Formula, if any, for indexing the phased retirement benefit Bridging benefit, payable from to , expressed as(a) a percentage of the accrued pension benefit to date %(b) an annual amount $Pension benefit payable at retirement:Formula for calculating the pension benefit payable at retirement 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 Statement date Former member’s name Date of birth Spouse’s or common-law partner’s name Date of birth Phased retirement benefit:Phased retirement benefit payable, expressed as(a) a percentage of the pension benefit being received prior to phased retirement period %(b) an annual amount $ 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 Formula, if any, for indexing the phased retirement benefit Bridging benefit, payable from to , expressed as(a) a percentage of the accrued pension benefit to date %(b) an annual amount $ Pension benefit payable at retirement:Formula for calculating the pension benefit payable at retirement 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 creditedNOTE: 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.I, , hereby certify that I am the spouse or the common-law partner, as defined in the Pension Benefits Standards Act, 1985, of .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 on , 20.Signature of spouse or common-law partner Address of spouse or common-law partner (home telephone number) (work telephone number) STATEMENT OF WITNESSI certify that(a) My full name is (b) My address is (c) I witnessed sign this waiver.(home telephone number) (work telephone number) I, , 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 , a retired former member of the pension plan known as .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 $ 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 $ 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 on the day of , 20Name of spouse or common-law partner Signature of spouse or common-law partner Name of witness (other than the former member)Signature of witness
Schedule V · (Sections 20, 20.1, 20.2 and 20.3)
1 To: (insert name of financial institution)2 List of applicable federally regulated locked-in plans: (Please identify any locked-in registered retirement savings plan, life income fund, restricted locked-in savings plan or restricted life income fund that is held by the financial institution identified above and from which you intend to withdraw or transfer funds.)(a) (b) (c) 3 AttestationI, (insert name) , of (insert address), in the city of , in the province of , attest to the following:I own the federally regulated locked-in plan(s) identified in item 2. On the day on which I sign this Attestation (choose all that apply):(A) Withdrawal for Expenditures on Medical or Disability-related Treatment or Adaptive Technology(a) | My total expected income for the calendar year, determined in accordance with the Income Tax Act (excluding the withdrawal referred to in line G below and any withdrawal made under paragraph 20(1)(d), 20.1(1)(m), 20.2(1)(e) or 20.3(1)(m) of the Pension Benefits Standards Regulations, 1985 within the last 30 days before this application) is $;(b) | I submit a letter signed by a physician certifying that medical or disability-related treatment or adaptive technology is required;(c) | I expect to make expenditures on the medical or disability-related treatment or adaptive technology specified in the physician’s certificate in the amount of $, which is greater than 20% of my total expected income for the calendar year;(d) | I have not made any other withdrawal, other than within the last 30 days before this application, during the calendar year under paragraph 20(1)(d), 20.1(1)(m), 20.2(1)(e) or 20.3(1)(m) of the Pension Benefits Standards Regulations, 1985; and(B) Withdrawal Based on Low Income | My total expected income for the calendar year, determined in accordance with the Income Tax Act (excluding the withdrawal referred to in line G below and any withdrawal made under paragraph 20(1)(d), 20.1(1)(m), 20.2(1)(e) or 20.3(1)(m) of the Pension Benefits Standards Regulations, 1985 within the last 30 days before this application), is less than three quarters of the Year’s Maximum Pensionable Earnings as defined in the Pension Benefits Standards Act, 1985.4 Amount Sought for WithdrawalA | Expected income in the calendar year determined in accordance with the Income Tax Act. | $ | | B | Total financial hardship withdrawals made during the calendar year from all federally regulated locked-in registered retirement savings plans, life income funds, restricted life income funds and restricted locked-in savings plans. | $ | | B(i): total low income component of B is | $ | | B(ii): total medical and disability-related income component of B is | $ | | C | 50% of the Year’s Maximum Pensionable Earnings as defined in the Pension Benefits Standards Act, 1985. | $ | | Calculation of Low Income Component of Withdrawal(To be completed only if seeking withdrawal under this component.)D | Low income withdrawal component. | | | D(i) | A - B | $ | D(ii) | 66.6% of D(i) | $ | D(iii) | C - D(ii) | $ | D(iv) | D(iii) - B(i) | $ | Enter amount from D(iv) if greater than zero, otherwise enter “0” | | | $Calculation of Medical and Disability-Related Component of Withdrawal(To be completed only if seeking withdrawal under this component.)E | E(i) Total expected medical and disability-related expenditures in the calendar year that a medical doctor certifies are required. | | $ | E(ii) | A - B | $ | E(iii) | 20% of E(ii) | $ | E(iv) | If E(i) is greater than or equal to E(iii), enter E(i), otherwise enter “0” | $ | E(v) Total expected medical and disability-related expenditures for which unlocking is being sought. | Enter the lesser of E(iv) and C | $ | Enter amount from E(v) | | | $Calculation of Financial Hardship WithdrawalF | Total amount eligible for financial hardship withdrawal. | | | F(i) | D + E | $ | F(ii) | C - B | $ | F(iii) | Enter the lesser of F(i) and F(ii) | $ | Enter amount from F(iii) | | | $G | Total amount sought for withdrawal. | | | | Enter F or a lesser amount | | | $5 SignaturesSworn before me, on the day of, 20 at , in the province of.Signature of applicant A notary public, commissioner or other person authorized to take affidavits1 To: (insert name of financial institution)2 List of applicable federally regulated locked-in plans: (Please identify any locked-in registered retirement savings plan, life income fund, restricted locked-in savings plan or restricted life income fund that is held by the financial institution identified above and from which you intend to withdraw or transfer funds.)(a) (b) (c) 3 Attestation of applicantI, (insert name) , of (insert address), in the city of , in the province of , attest to the following:I own the federally regulated locked-in plan(s) identified in item 2. I intend to withdraw or transfer $ from the plan(s). On the day on which I sign this Attestation (check one):(a) | I do not have a spouse or common-law partner, as defined in section 2 of the Pension Benefits Standards Act, 1985;(b) | I have a spouse or common-law partner, as defined in section 2 of the Pension Benefits Standards Act, 1985, and my spouse or common-law partner consents to the withdrawal of the amount specified above from the locked-in plan(s) identified in item 2. (If you check this box, your spouse or common-law partner must complete the Attestation of Spouse or Common-law Partner, in item 6 below.)4 AcknowledgementsI understand that when funds are withdrawn or transferred from any federally regulated locked-in plan, the funds may lose the creditor protection provided by the Pension Benefits Standards Act, 1985 and the Pension Benefits Standards Regulations, 1985.I understand that when funds are withdrawn or transferred from any federally regulated locked-in plan, the funds may be taxable under the Income Tax Act or other legislation.I understand that I may need to seek professional advice about the financial and legal implications of such a withdrawal or transfer.5 SignaturesSworn before me, on the day of, 20 at , in the province of.Signature of applicant A notary public, commissioner or other person authorized to take affidavits6 Attestation of Spouse or Common-law PartnerI, (insert name) , of (insert address), in the city of , in the Province of , attest to the following:I am the spouse or common-law partner of the owner of the locked-in plan(s) identified in item 2.I understand that(a) the applicant intends to withdraw or transfer funds from the federally regulated locked-in plans identified in item 2, which withdrawal or transfer is not permitted under the Pension Benefits Standards Act, 1985 unless the applicant obtains my consent;(b) as long as these funds are kept in that federally regulated locked-in plan, I may have a right to a share of these funds if there is a breakdown in our relationship or if the owner dies;(c) if any funds are withdrawn or transferred from that federally regulated locked-in plan, I may lose any right that I have to a share of the funds withdrawn or transferred;(d) when funds are withdrawn or transferred from any federally regulated locked-in plan the funds may lose the creditor protection provided by the Pension Benefits Standards Act, 1985 and the Pension Benefits Standards Regulations, 1985;(e) when funds are withdrawn or transferred from any federally regulated locked-in plan the funds may be taxable under the Income Tax Act or other legislation; and(f) I may need to seek professional advice about the financial and legal implications of such a withdrawal or transfer.7 Consent of Spouse or Common-law PartnerI consent to the withdrawal or transfer specified in item 3.8 SignaturesSworn before me, on the day of, 20 at , in the province of.Signature of spouse or common-law partner A notary public, commissioner or other person authorized to take affidavits1 To: (insert name of financial institution)2 List of applicable federally regulated locked-in plans: (Please identify all locked-in registered retirement savings plan, life income fund, restricted locked-in savings plan or restricted life income fund which you own including any that are held by financial institutions other than the one identified above.)(a) (b) (c) 3 AttestationI, (insert name) , of (insert address), in the city of , in the province of , attest to the following:I own the federally regulated locked-in plans identified in item 2. On the day on which I sign this Attestation the total value of all of the locked-in plan(s) identified in item 2 is $.On the day on which I sign this Attestation the total value of all of the locked-in plan(s) identified in item 2 is $.The total value of all locked-in plan(s) identified in item 2 is less than 50% of the Year’s Maximum Pensionable Earnings as defined in the Pension Benefits Standards Act, 1985.4 SignaturesSworn before me, on the day of, 20 at , in the province of.Signature of applicant A notary public, commissioner or other person authorized to take affidavits
Schedule VI · (Section 10.2)
I, the undersigned, an officer of the employer, having been duly authorized by the Board of Directors, declare that(a) the employer does not anticipate being able to remit the special payments required under subsection 9(1.1) of the Pension Benefits Standards Act, 1985 without seriously impairing the ability of the employer to continue in operation; and(b) the employer intends to negotiate with the representatives of the members and former members with the purpose of entering into a workout agreement.I, the undersigned, an officer of the employer, having been duly authorized by the persons who have the authority to direct or authorize the actions of that body, declare that(a) the employer does not anticipate being able to remit the special payments required under subsection 9(1.1) of the Pension Benefits Standards Act, 1985 without seriously impairing the ability of the employer to continue in operation; and(b) the employer intends to negotiate with the representatives of the members and former members with the purpose of entering into a workout agreement.I, the undersigned, an officer of the employer, having been duly authorized by the Board of Directors, declare that(a) the employer is subject to proceedings under the Companies’ Creditors Arrangement Act or Part III of the Bankruptcy and Insolvency Act; and(b) the employer intends to negotiate with the representatives of the members and former members with the purpose of entering into a workout agreement.I, the undersigned, an officer of the employer, having been duly authorized by the persons who have the authority to direct or authorize the actions of that body, declare that(a) the employer is subject to proceedings under the Companies’ Creditors Arrangement Act or Part III of the Bankruptcy and Insolvency Act; and(b) the employer intends to negotiate with the representatives of the members and former members with the purpose of entering into a workout agreement.
Amendments not in force
— SOR/2026-62, s. 1The long title of the Pension Benefits Standards Regulations, 1985 is replaced by the following:note — SOR/2026-62, s. 2Section 1 of the Regulations and the heading before it are repealed. — SOR/2026-62, s. 3The Regulations are amended by adding the following after section 10:Transfer of Assets — Person Who Cannot be LocatedFor the purposes of subsection 10.3(3.2) of the Act, the following persons are prescribed:the person whose pension benefit credit relates to the transferred assets; andif that person is deceased,their survivor, if there is one,if there is no survivor, the person’s designated beneficiary, andif there is neither a survivor nor a designated beneficiary, the executor of the person’s will, the administrator of their estate or the liquidator of their succession on behalf of the estate or succession.For the purposes of subsection 10.3(3.3) of the Act, the prescribed information that must be provided to the designated entity isin respect of the relevant person who cannot be located,their name and the name of their spouse, common-law partner and designated beneficiary, if any, listed on the records of the administrator,their postal and email addresses listed on the records of the administrator,their date of birth, andtheir social insurance number;the date on which the person became a member of the pension plan or, if any of their benefits under the plan accrued under any other pension plan, the date on which the benefits started to accrue;the date on which the person ceased to accrue pension benefits;the date of the transfer of assets;the amount transferred;the name and registration number of the pension plan at the date of the transfer;the names of the employers that contributed to the pension plan in respect of the person and, if any of the person’s benefits under the plan accrued under any other pension plan, the names of the employers that contributed to fund the benefits; andthe name and address, at the date of transfer, of the administrator of the pension plan from which the assets are transferred or, if the trustee or custodian of the pension fund has been approved by the Superintendent to make the transfer, the name and address, at the date of transfer, of the trustee or custodian of the pension fund from which the assets are transferred.For the purposes of subsection 10.3(3.4) of the Act, the prescribed information that the designated entity may publish isthe name of the person who cannot be located;the person’s postal and email addresses listed on the records of the administrator;the date on which the person became a member of the pension plan or, if any of their benefits under the plan accrued under any other pension plan, the date on which the benefits started to accrue;the date on which the person ceased to accrue pension benefits;the date of transfer of assets;the amount transferred;the name and registration number of the pension plan at the date of the transfer; andthe names of the employers that contributed to the pension plan in respect of the person and, if any of the person’s benefits under the plan accrued under any other pension plan, the names of the employers that contributed to fund the benefits.For the purposes of subsection 10.3(4) of the Act, the prescribed period of time is30 years, if the amount transferred is under $1,000; and100 years in any other case.
Federal laws of Canada reproduced under the Reproduction of Federal Law Order (SI/97-5); not the official version. Source: Justice Laws Website.