WORKERS UNITED CANADA RETIREMENT PLAN (the ‘Plan’)
Registration of Personal Information and Beneficiary Designation Form
REGISTRATION NO. 0351791
Section 1.  Member Information – You should inform the Plan administrator immediately of any changes to this information.
Social Insurance Number (SIN) - -
Date of Birth D DM MY Y Y Y
Gender
 
Cell/Mobile No. - -
Home Telephone No. - -
Language
Relationship Status
Date of Hire D DM MY Y Y Y
Section 2.  Spousal Information – If you have a spouse, provide spousal information below. Please see below for definition of spouse in your province.
Date of Birth D DM MY Y Y Y
Gender
Section 3.  Designation of Beneficiary(ies)

In the event of your death before receiving a benefit from the Plan, any pre-retirement death benefit that becomes payable will be paid to the person who is your spouse on your date of death. If you do not have a spouse (or in some provinces, where spouses are living separate and apart) or, if your spouse has waived their entitlement, the pre-retirement death benefit is payable to your designated beneficiary. If you have not designated a beneficiary, any benefit that becomes payable will be paid to your estate.

IF YOU DESIGNATE MORE THAN ONE BENEFICIARY, THE TOTAL OF THE DESIGNATED PERCENTAGES MUST EQUAL 100%.

BENEFICIARY:
 
Designation of Underage Beneficiary:

If any of the beneficiaries you have designated are under the age of majority, you must name a trustee to receive and disperse monies payable during minority.

I hereby appoint , my , if living, as trustee to receive any monies payable to the above-named child(ren) during minority, and any payment made to the trustee shall discharge the Plan to the extent of such payment.

Section 4.  Authorization – Before signing this form, you should understand the meanings of the “Explanation” and the “Authorization”, below. If clarification is needed, please contact the Plan administrator.

EXPLANATION – Your participation in the Plan depends on the collection, storage and use of certain personal information about you, your spouse and beneficiaries. That information comes from this form, the reports your employer(s) submit to the Plan and the applications made for benefit entitlements. It is stored by the Plan administrator, and it is used to: communicate with you; compute your benefits; satisfy the reporting requirements of the provincial and federal governments; pay taxes, comply with civil and criminal law; estimate future operating costs; accommodate audits of the Plan and, if applicable, transfer data to a new replacement plan. Personal information will be used for no other purpose without your express written permission and will be kept confidential and secure. Also, it is available for your review by contacting the Plan administrator.

AUTHORIZATION – I hereby authorize the Trustees and the Plan administrator to collect, record, use, disclose and, if applicable, destroy the personal information noted on this form. This authorization will survive as long as personal information is needed to fulfill my benefit entitlements or until I revoke it in a manner that does not contravene the law. However, I realize that such revocation may impair or cancel my participation in the Plan. Furthermore, I certify that the information given in this form is true, correct and complete, to the best of my knowledge and belief, and that I have the consent of my spouse and beneficiaries to provide their information as it appears on this form. I authorize the use of my SIN as an additional verification of my identity in the administration of my benefit entitlements and in the handling of any related tax matters. I understand that my SIN will be kept in the strictest confidence and will only be used for the specified purposes.

An audit record (your name, the date/time, and your device’s general info) is captured on submission as proof of signing.

WORKERS UNITED CANADA RETIREMENT PLAN
110 – 61 International Blvd., Toronto, ON  M9W 6K4
Email: wucrp@pbas.ca  •  Telephone: (416) 674 3350  •  1 (800) 461 4361  •  Fax No.: (416) 674 0992

Definition of Spouse:

ALBERTA

  1. A person who, at the relevant time, is married to you and has not been living separate and apart from you for a continuous period longer than three (3) years; or,
  2. if (a) does not apply, a person who at the relevant time, has been living with you in a marriage-like relationship:
    1. for a continuous period of at least three (3) years; or,
    2. of some permanence, if there is a child of the relationship by birth or adoption.

BRITISH COLUMBIA

  1. A person who at the relevant time, is married to you and has not been living separate and apart from you for a continuous period longer than two (2) years; or,
  2. person who was living with you in a marriage-like relationship for a period of at least two (2) years.

MANITOBA

A person who, at the relevant time:
  1. is married to you; or,
  2. registered a common-law relationship with you under Section 13.1 of The Vital Statistics Act; or,
  3. not being married to you, cohabited with you in a conjugal relationship;
    1. for a period of at least three (3) years preceding the relevant time, if either of you is married; or,
    2. for a period of at least one (1) year preceding the relevant time if neither of you is married.

ONTARIO

A person who, at the relevant time:
  1. is married to you; or,
  2. is not married to you and is living together with you in a conjugal relationship:
    1. continuously for a period of not less than three (3) years; or,
    2. in a relationship of some permanence, if you are the parents of a child as set out in Section 4 of the Ontario Children’s Law Reform Act.

SASKATCHEWAN

A person who, at the relevant time:
  1. is married to you; or,
  2. if you are not married, a person with whom you are cohabitating as spouses at the relevant time and who has been cohabitating continuously with you as your spouse for at least one (1) year prior to the relevant time.