Registration of Personal Information & Beneficiary Designation

Your participation in the Plan depends on the collection, storage and use of certain personal information about you, your spouse and beneficiaries. It is used to communicate with you, compute your benefits, meet government reporting requirements, pay taxes, comply with the law, estimate costs, accommodate audits and, if applicable, transfer data to a replacement plan. It will not be used for any other purpose without your written permission and is kept confidential and secure.

I authorize the Trustees and Plan administrator to collect, record, use, disclose and, if applicable, destroy the personal information on this form. I certify the information is true, correct and complete, and that I have the consent of my spouse and beneficiaries. I authorize the use of my SIN to verify my identity and for related tax matters; it will be kept confidential and used only for the specified purposes.