Registration of Personal Information and Beneficiary Designation Form

Section 1 — Member information

Please inform the Plan administrator immediately of any changes to this information.

Section 2 — Spousal information

If you have a spouse, provide your spouse’s information below. See the “Definition of spouse” at the end of this form for your province.

Section 3 — Designation of beneficiary or beneficiaries

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%.

Section 4 — Authorization

Before signing this form, please read the “Explanation” and the “Authorization” below. If you need clarification, 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 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. It is also available for your review by contacting the Plan administrator.

Authorization

I 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. I realize that such revocation may impair or cancel my participation in the Plan. 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.