New Plan/Amendment Return

New plan effective date Y M D

Amendment effective date Y M D

Type of action - Question identifier:1.

Jurisdiction of registration

• 10: Newfoundland and Labrador
• 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
• 70: Quebec/Federal
• 00: Not registered with pension authority

Type of action - Question identifier:2.

Plan registration number

Type of action - Question identifier:3.

Name of employer or plan sponsor

Type of action - Question identifier:4a.

Mailing address of person indicated in Question 3 above

Type of action - Question identifier:4b.

Postal / Zip code

Type of action - Question identifier:5.

Title of plan

Type of action - Question identifier:6.

Nature of business of principal employer

Type of action - Question identifier:7.

Type of organization of principal employer(s) - Public Sector

• 01: Municipal government
• 02: Municipal enterprise
• 03: Provincial government
• 04: Provincial enterprise
• 05: Federal government
• 06: Federal enterprise
• 07: Other

Type of organization of principal employer(s) - Private Sector

• 08: Incorporated company
• 09: Unincorporated business (sole proprietor or partnership)
• 10: Co-operative
• 11: Trade or employee association
• 12: Religious, charitable or other non-profit organization
• 13: Other (describe)

Type of action - Question identifier:8.

Number of employers

• 1: One
• 2: More than one, multi-employer plan
• 3: More than one, not a multi-employer plan

Type of action - Question identifier:9.

Included employment

Are any members employed in an activity that is within the authority of the federal Pension Benefits Standards Act? (For example, activity relating to communication, banking or interprovincial transportation.)

• 01: No
• 15: Yes

Type of action - Question identifier:10.

Plan fiscal year end

Month day

Type of action - Question identifier:11.

Funding instrument (check one or more)

• 01: Insurance company contract - fully guaranteed
• 06: Insurance company contract - not fully guaranteed
• 07: Trust agreement
• 09: Pension fund society
• 10: Government Consolidated Revenue Fund
• 11: Other (describe)

Type of action - Question identifier:12.

Eligibility - Class(es) of employees (multiple entries acceptable, except if "All employees" has been checked)

• 1: All employees
• 2: Salaried
• 3: Hourly
• 4: Executives (including significant shareholders/connected persons)
• 5: Supervisory
• 6: Union employees
• 7: Non-union employees
• 8: Other (describe)

Type of action - Question identifier:13.

Eligibility - new employees

• 1: Compulsory membership
• 2: Voluntary membership
• 3: Closed to new members
• 4: Other (describe)

Type of action - Question identifier:15.

Integration with C/QPP (contribution and/or benefit)

• 1: Yes
• 2: No

Type of action - Question identifier:16.

Type of plan (pension formula for current service)

• 01: Final average earnings over last ___ years
• 02: Average best earnings - for the best __ years
• 03: Average best earnings - for the best __ years of the last __ years
• 04: Career average earnings - year earnings base last
  updated ____ earnings indexed yes no
• 05: Flat benefit
• 06: Money purchase
• 07: Profit sharing
• 08: Hybrid - better of defined benefit / defined contribution
• 09: Composite / combination
• 10: Defined benefit / defined contribution
• 11: Other (describe)

Type of action - Question identifier:17.

Employee contribution rate - current service

• 1: No contributions required
• 2: ____ % of earnings (not integrated)
• 3: ____ % of earnings less the required C/QPP contributions
• 4: ____ % of earnings up to YMPE or on which contributions to C/QPP are required and ____ % on balance of earnings
• 5: $ ____ per year
• 6: ____ cents per hour
• 7: Up to 18% of earnings (together with employer contributions), as prescribed by the Income Tax Act
• 8: Variable (describe)
• 9: Other (describe)

Type of action - Question identifier:18.

Employee voluntary additional contributions

• 1: Yes
• 2: No

Type of action - Question identifier:19.

Employer contribution rate - current service

• 01: Balance of cost of pension, i.e. defined benefit plan (other than modified defined benefit)
• 02: As specified in collective agreement (use only for
  modified defined benefit plans, if specific rate is not
  known)
• 03: ____ % of earnings (not integrated)
• 04: ____ % of earnings less the required C/QPP contributions
• 05: ____ % of earnings up to YMPE or on which contributions to C/QPP are required and ____ % on balance of earnings
• 06: $ ____ per year
• 07: ____ cents per hour
• 08: Based on employer profits with minimum of ____ % of employee's earnings
• 09: Up to 18% of earnings (together with employee contributions, if any), as prescribed by the Income Tax Act
• 10: Variable (describe)
• 11: Other (describe)

Type of action - Question identifier:20.

Current service benefits

• 1: Defined contribution plan, i.e. benefit not prescribed
• 2: ____ % of earnings for each year of service (not integrated)
• 3: ____ % of earnings for each year of service less all or part of C/QPP pension
• 4: ____ % of earnings up to YMPE or on which contributions to C/QPP are required and ____ % on balance of earnings for each year of service
• 5: $ ____ per month for each year of service
• 6: $ ____ per month for every ____ hours worked
• 7: Combination of benefit formulae
• 8: Variable (describe)
• 9: Other (describe)

Type of action - Question identifier:21.

Bridging supplement on retirement before age 65

• 1: Yes
• 2: No

Type of action - Question identifier:22.

Disability benefits provided

• 1: Yes
• 2: No

Type of action - Question identifier:23.

Normal retirement

• 1: Age ____
• 2: Other (describe)

Type of action - Question identifier:24.

Special retirement (no reduction in pension) (check one or more)

• 1: Not applicable - no special retirement
• 2: Age ____
• 3: Year of service___
• 4: Age plus service equals____
• 5: Combination of three conditions
• 6: Other (describe)

If more than one of the above is indicated, which conditions must apply

• 1: Both
• 2: Either

Type of action - Question identifier:37.

Number of active members covered by plan at plan year end for Men and Women for:

• 1: Newfoundland and Labrador
• 2: Prince Edward Island
• 3: Nova Scotia
• 4: New Brunswick
• 5: Quebec
• 6: Ontario
• 7: Manitoba
• 8: Saskatchewan
• 9: Alberta
• 10: British Columbia
• 11: Yukon
• 12: Northwest Territories
• 13: Nunavut
• 14: Outside Canada
• 15: Total

Note: Questions 28, 33 and 34 apply to defined benefit plans only.

Type of action - Question identifier:28.

Automatic adjustment to pensions provided for in plan (Note: if different formula used for pensions in pay and deferred pensions, give formula for pensions in pay)

• 1: No automatic adjustment provided for in plan
• 2: Based on full consumer price index (CPI)
• 3: Based on partial CPI
• 4: Based on excess interest earnings
• 5: Percentage increase __.__ %(not based on CPI)
• 6: Other (describe)

Type of action - Question identifier:33.

Death benefits after retirement - normal form of pension for single pensioner

• 1: Life annuity
• 2: Pension guaranteed for _____ months
• 3: Employee contributions less pension payments made
• 4: Total contributions less pension payments made
• 5: Other (describe)

Type of action - Question identifier:34.

Death benefits after retirement - for married pensioner

• a): Is joint and survivor or spouse's pension provided (if not waived)?
  
  1 Yes, at _____ % of retiree's pension
  2 No
• b): If yes, is the initial pension benefit reduced to provide this type of benefit?
  
  1 Yes
  2 No

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