Annual Update Return

12 month period
Original return
___ month period
Revision

Name of employer or plan sponsor

Plan registration number

Reference date for membership/contribution data

• 1: YYYY MM DD

Uniform Statistical Program - Question identifier:1.

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

Uniform Statistical Program - Question identifier:2.

Contributions

Employee contributions $ (Omit cents)

• 1: Required
• 2: Voluntary
• 3: Total

Employer contributions

• 1: current service required contributions
• 2: Less: termination and death credits and surplus assets used
• 3: Equals: current service contributions made
• 4: Add: special payments - unfunded liability and experience/solvency deficiency
• 5: Equals: total employer contributions

Uniform Statistical Program - Question identifier:3.

Plan assets (all plans) - report only if available for same period as membership/contribution data $ (Omit cents)


Total net assets - book value
Total net assets - market value

COMPLETE QUESTIONS 4 TO 6 ONLY FOR DEFINED BENEFIT PLANS
- OTHERWISE LEAVE BLANK

Uniform Statistical Program - Question identifier:4.

Number of non-active members (excluding persons for whom individual annuities have been purchased) Report only if available for same period as membership/
contribution data.

• 1: Pensioners and beneficiaries
• 2: Vested former members entitled to deferred pension
• 3: Total non-active members

Uniform Statistical Program - Question identifier:5.

Adjustments to pension benefits

In the year preceding the reference date for membership/contribution data, were adjustments made to pensions in pay? (Adjustments must apply to at least 25% of plan members.)

• 01: No
• 02: Yes - in accordance with a requirement of the plan
  for regular adjustment of benefits
• 03: Yes - pursuant to a collective agreement
• 04: Yes - voluntarily by the employer
• 05: Yes - other (describe)
  
  IF RESPONSES 3 TO 5 GIVEN FOR QUESTION 5, COMPLETE THE FOLLOWING QUESTION.

Uniform Statistical Program - Question identifier:6.

Basis for adjustment

• 01: Full consumer price index (CPI)
• 02: Partial CPI
• 03: Based on excess interest earnings
• 04: Percentage increase __.__% (not based on CPI)
• 05: Flat dollar increase $ __,__ annually(convert if necessary)
• 06: Other method (specify)

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