APPLICATION TO RECEIVE A LUMP SUM PAYMENT FROM THE SHEET METAL WORKERS LOCAL 30 PENSION PLAN Registration Number

Transcription

1 APPLICATION TO RECEIVE A LUMP SUM PAYMENT FROM THE SHEET METAL WORKERS LOCAL 30 PENSION PLAN Registration Number Administrator's Office: Union Office: Employee Benefit Plan Services Limited Sheet Metal Workers Local Union McIntosh Drive 14 Cosentino Drive Markham, Ontario L3R 8C7 Scarborough, Ontario, M1P 3A2 Telephone: , Toll Free Telephone: Web Site: Plan Member's Name: Street Address: Apt. No. City/Province/Postal Code: Social Insurance Number: Home Telephone Number: ( Date of Birth: ) Name of Last Contributing Employer: Date last worked for a Contributing Employer: 20 ENERAL INFORMATION Who should use this Form? 1. A Member in ood Standing of Local Union 30 who, although remaining such a Local Union Member, is not yet Age 53 and has not worked for an Employer contributing to the Pension Plan for at least 24 consecutive months, and who wishes to transfer out of the Pension Plan the Commuted Value of the Pension earned to date. 2. A person who is no longer a Member in ood Standing of Local Union 30, who is Vested and not yet Age 53, who wishes to transfer the Commuted Value of the Pension earned to date. 3. A person who is no longer a Member in ood Standing of Local Union 30, and who is not Vested, and is applying for a Refund. Not available for persons who terminate Local 30 Membership on or after January 1, A Spouse, Beneficiary or representative of the Estate, with respect to a Pension Plan Member who died prior to the date his/her Monthly Pension started. In accordance with the Pension Benefits Act, Ontario, the deceased Pension Plan Member's Spouse has a prior right to receive the Death Benefit provided by the Pension Plan. ADMINISTRATOR'S USE ONLY Date received: 20 Date processed: 20 In use effective March, 2006 Privacy Statement: The Plan will collect, maintain and communicate only the Personal Information considered necessary for the administration of the Plan. Personal Information will be protected pursuant to the relevant provincial legislation. The Plan may use and exchange information with relevant persons or organizations (institutions, investigative agencies, regulators) in order to manage the Plan and the entitlement to the Benefits of the Plan. Questions related to the Privacy Policy of the Plan should be directed to the Administrator.

2 APPLICATION FOR TRANSFER OF COMMUTED VALUE SHEET METAL WORKERS LOCAL 30 PENSION PLAN Registration Number I am the person named in this Application, and I am not yet Age 53. Evidence of my date of birth accompanies this Application. I am applying to have the Administrator calculate the Commuted Value of the Monthly Pension earned to the last day I worked with a Contributing Employer, because: I am no longer a Member in ood Standing of Local Union 30; or I am a Member in ood Standing of Local Union 30, and I have not worked for a Contributing Employer for at least the 24 consecutive months immediately preceding my Application. I understand that the Commuted Value of my Monthly Pension is for the exclusive purpose of eventually providing me a Monthly Pension, or a Death Benefit to my Spouse or Beneficiary in the event of my death before retirement. I request that the Commuted Value be transferred to: A Locked-In Registered Retirement Savings Plan. A Canadian Life Insurance Company, for the purpose of purchasing an Annuity that will commence payments on or after my 53rd birthday, and that will be paid in accordance with any governing Legislation. Another Pension Trust Fund which provides a Registered Pension Plan. I understand that the Administrator cannot process my Application to transfer the Commuted Value unless and until I supply the Administrator:! The completed Certification of Local Union 30, attached; and! If the money is being transfer to a Locked-In RRSP, or to a Canadian Life Insurance Company, written documentation from the receiver that the money so transferred will be in accordance with The Pension Benefits Act, Ontario, as well as a special Form available from Revenue, Canada which allows the Administrator to transfer the money free of Tax; or! If the money is being transferred to another Pension Trust Fund, written confirmation from the receiver that both confirms that the other Pension Trust Fund is the Sponsor of a Registered Pension Plan, and further that the receiver has agreed to receive the Commuted Value. (Plan Member's Signature) 20 (Date Signed)

3 CERTIFICATION BY SHEET METAL WORKERS LOCAL UNION 30 Applicant=s Name: I am an Officer of Sheet Metal Workers Local Union 30, and I certify that the information appearing below is true and correct, to the best of my knowledge, as at the date appearing below: The Applicant is a Member in ood Standing of Local Union 30, and has not been employed by a Pension Plan Contributing Employer since ; or The Applicant is no longer a Member in ood Standing of Local Union 30, as at. (Officer's Name) (Officer's Signature) 20 (Date Signed)

4 LOCKIN-IN AREEMENT BETWEEN: HEREIN CALLED THE ANNUITANT AND HEREIN CALLED THE DEPOSITORY The Annuitant established a Retirement Savings Plan with the Depository, such Plan to be registered in accordance with Section 146 of the Income Tax Act (Canada). The Annuitant and the Depository hereby covenant and agree that the sum of $ which will be transferred to his/her Plan by the Trustees of the Sheet Metal Workers Local 30 Pension Trust Fund will be Locked-In and not available to the Annuitant in the form of Cash. The Plan shall at maturity or termination prior to maturity, be used to purchase an Annuity payable for the Annuitant s lifetime at least. Such Annuity may or may not include additional provisions as may be permitted under Section 146 of the Income Tax Act. It is understood that the above sum which represents the value of a non-commutable pension under Section 21 of The Ontario Pension Benefits Act (1987) may not be used for any purpose other than the purchase of a Life Annuity as Stated above, and that the transfer of these funds is contingent upon execution of this Agreement. Dated this day of 20 ANNUITANT AUTHORIZED OFFICIAL DEPOSITORY PRINTED NAME AND TITLE

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