R-17.0.1, r. 3 - Regulation respecting voluntary retirement savings plans

Schedule Disposition versions

2014-07-01

SCHEDULE A

(s. 29)

DECLARATION OF THE MEMBER

I declare:

(1) that the total of the locked-in amounts credited to my accounts in the following pension plans:

(a) defined contribution pension plans;

(b) defined benefit or defined benefit-defined contribution pension plans in application of provisions similar to those of a defined contribution plan;

(c) life income funds;

(d) locked-in retirement accounts;

(e) voluntary retirement savings plans governed by the Voluntary Retirement Savings Plans Act (chapter R-17.0.1),

is $_____________;

(2) that the total is based on the most recent information that I have;

(3) that the said information is less than 18 months old.

(Date)______________ (Signature) __________________________

O.C. 499-2014, Sch. A.