Name of Sponsoring Company
Date of Incorporation
Submitted as DD/MM/YYYY.
Corporate Year End
Plan Member Name
Plan Member Gender
Plan Member Date of Birth:
Plan Member Date of Hire
Plan Member Province of Residence
—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
(DO NOT INCLUDE DIVIDENDS OR OTHER INCOME)
*Do not include current year’s unused room. Do not make RRSP contributions in the year an IPP is set up.
CURRENT MARKET VALUE OF RRSP
*UNUSED RRSP DEDUCTION ROOM AS OF 12/31/2021
Is the member a Connected Person? (Owns or is married to shareholder with 10% or more of Company’s shares)
Is the Participant a member of another Registered Pension Plan?
Will any additional related corporations be contributing to the pension plan?
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