Termination/Transfer/Miscellaneous Return

Name of employer or plan sponsor

Plan registration number

Reference date for termination,transfer, etc.

• 1: YYYY MM DD

CHECK ONE OF THE FOLLOWING AND PROVIDE REQUESTED INFORMATION

Uniform Statistical Program - Question identifier:1.

Plan termination (for total terminations only)

Reason for termination

• 01: Replaced by new plan no.
• 02: Merged with plan no.
• 03: Bankruptcy
• 04: No members left in plan
• 05: Non-approval by Canada Customs and Revenue Agency
• 06: Company dissolved
• 07: Financial/administrative considerations
• 08: Replaced by RRSPs
• 10: Non-compliance
• 11: Other (specify)
• 12: No reason given

Number of members affected
Total net value of plan assets
Value of benefits of members affected
Surplus of assets in the plan
Amount of surplus assets allocated to affected members
Debt of employer, if any

Uniform Statistical Program - Question identifier:2.

Plan transfer (to be reported by the "from" jurisdiction)

Transfer from:

• 10: Newfoundland
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 62: Federal
  
  To:

• 10: Newfoundland
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 62: Federal

Uniform Statistical Program - Question identifier:3.

Other - Explain (Use to report minor amendments in lieu of completing "New plan/Amendment return" (if desired) or to report other miscellaneous events such as plan reactivations.)

Completed by (please print):

Telephone no.:

Date:

Please return completed forms to:
Pensions and Wealth Surveys Section
Income Statistics Division
Statistics Canada
Ottawa, Ontario K1A 0T6
Telephone: (613) 951-4031
Fax: (613) 951-4296

Thank you for your cooperation