Commencement

These Regulations shall come into force on the 1st day of January, 2017. MADE by the Minister responsible for pensions this 3rd day of January, 2017. (Rt. Hon. Dean Barrow) Prime Minister and Minister of Finance and Home Affairs (Minister responsible for Pensions) __________ Private Pensions 71 SCHEDULE I [regulations 3, 7, 11, 19 and 49] FORM 1(a) THE PRIVATE PENSIONS ACT The Private Pensions Regulations APPLICATION FOR LICENCE AS AN ADMINISTRATOR (section 6(1)(d), (e) or (f)) PART A: Applicant’s Information Name of Organization: ________________________________ Permanent Address: __________________________________ __________________________________________________ Mailing Address (if different from above): ________________ __________________________________________________ Tel: _____________________ Fax: ______________________ Email: ___________________ Website: __________________ Tax Identification Number: ____________________________ Contact Person: _____________________________________ Address: ___________________________________________ Tel: _____________________ Fax: ______________________ 72 Private Pensions Email: __________________ Nationality: _______________ Occupation: ________________________________________ PART B: Financial Institution/Entity A) Please indicate paid up share capital of Financial Institutional/Entity: ____________________________ B) Please include five (5) year’s business plan. C) Please include Article & Memorandum of Association. D) Please include Biographical Affidavit for shareholders. Please read these instructions in their entirety. Failure to comply with these instructions may delay the approval of your application. Supporting documents required: 1. Copies of Photo IDs of shareholders 2. A certified copy of Company Registry Annual Returns 3. Proof of address for shareholders 4. Proof of address for Entity Private Pensions 73 DECLARATION STATEMENT I/WE __________________________________ certify that: 1. The documents submitted with this form include true and current copies that create and support this application. 2. l/WE understand that the obligation to ensure that the documents submitted with this Form comply with the Act and the Regulations is the responsibility of the employer/financial Institution, and I declare that I have fulfilled that obligation and have complied with the provisions of the Act and the Regulations in making this application for registration. CAP. 30:01. 3. I/WE consent to the Supervisor of Pension to obtain information from any source as permitted by the Laws of Belize or any other jurisdiction for the purpose of verifying the information submitted in support of this application. I declare that I am aware of the obligations under the Act as an Administrator establishing the Pension Plan and that the contents of this form and the documents submitted with this form, and my declarations are true to the best of my knowledge and belief. DATED this _____ day of ________________ , 20 ______ . (Please Print Name of Authorized Signature) (Name of Witness - Please Print) (Authorized Signature) (Signature of Witness) 74 Private Pensions FOR OFFICIAL USE ONLY: Approved by: Registration # _____________ ________________________ Receipt # _____________ (Supervisor of Pension) ______________________ O.S.I.P.P. OFFICIAL STAMP (dd/mm/yyyy) Private Pensions 75 SUPERVISOR OF PENSIONS FORM 1(b) THE PRIVATE PENSIONS ACT The Private Pensions Regulations REGISTRATION OF AN ADMINISTRATOR (section 6(1)(a), (b) or (c)) PART A: Applicant's Information if proposed Administrator is Employer Name of Organization: ________________________________ Permanent Address: __________________________________ Mailing Address (if different from above): ________________ Tel: _____________________ Fax: ______________________ Email: ___________________ Website: __________________ Tax Identification Number: ____________________________ Contact Person: _____________________________________ Address: ___________________________________________ Tel: _____________________ Fax: ______________________ Email: ___________________ Nationality: ________________ Occupation: ________________________________________ 76 Private Pensions PART B: Applicant's Information if proposed Administrator is Board of Trustees (section 6(1)(b) & (c) Name of Trustees Please Indicate if: Employer Representative or Member Representative 1. ________________________________________________ 2. ________________________________________________ 3. ________________________________________________ 4. ________________________________________________ 5. ________________________________________________ 6. ________________________________________________ Notes/Instructions: Please read these instructions in their entirety. Failure to comply with these instructions may delay the approval of your application. Supporting documents required: 1. Photo ID of all trustees, contact person(s) for employer and authorize signatory(ies) for entity(ies) 2. A certified copy of Certificate of Registration of Corporate Trustees 3. Proof of address for each trustee 4. Proof of address for Entity (i.e. Employer) 5. Completed Biographical Affidavit for all members of Board of Trustees Private Pensions 77 Declaration Statement I/we ____________________________________ certify that: 4. The documents submitted with this form include true and current copies that create and support this application. 5. I/WE understand that the obligation to ensure that the documents submitted with this Form comply with the Act and the Regulations is the responsibility of the employer/financial Institution, and I declare that I have fulfilled that obligation and have complied with the provisions of the Act and the Regulations in making this application for registration. CAP. 30:01. 6. I/WE consent to the Supervisor of Pension to obtain information from any source as permitted by the Laws of Belize or any other jurisdiction for the purpose of verifying the information submitted in support of this application. I/We declare that I am/ We are aware of the obligations under the Act as an Administrator establishing the Pension Plan and that the contents of this form and the documents submitted with this form, and my declarations are true to the best of my knowledge and belief. DATED this _______ day of _________________ 20 ______ _____________________________________________________________________ (Please Print Name of Authorized Signature) (Name of Witness - Please Print) (Authorized Signature) (Signature of Witness) (Please Print Name of Authorized Signature) (Name of Witness - Please Print) (Authorized Signature) (Signature of Witness) 78 Private Pensions (Please Print Name of Authorized Signature) (Name of Witness - Please Print) FOR OFFICIAL USE ONLY: Approved by: Registration # _____________ ______________________ Receipt # _____________ (Supervisor of Pension) _____________________ O.S.I.P.P. OFFICIAL STAMP (dd/mm/yyyy) __________ Private Pensions 79 FORM 2 THE PRIVATE PENSIONS ACT The Private Pensions Regulations APPLICATION FOR REGISTRATION OF A PENSION PLAN (All questions must be completed except where indicated - please type or print) 1. Provide the name and address of the employer or financial institution sponsoring the pension plan: Employer/Financial Institution: ______________________ Permanent Address: _______________________________ _______________________________________________ Mailing Address (if different from above): _____________ _______________________________________________ Telephone: ____________ Fax: ______________________ Email: _______________ Website: __________________ Contact Person: __________________________________ Post: ___________________________________________ 2. Name of the Pension Plan: _________________________ 3. Commencement date of Plan: _______________________ 4. End of fiscal year for Plan: _________________________ 80 Private Pensions 5. Is the plan established pursuant to a collective agreement? [ ] Yes [ ] No If "yes", attach to this form a copy of the collective agreement. 6. Is there a predecessor pension plan? [ ] Yes [ ] No If "yes", provide the name and an explanation of the current status of the predecessor pension plan(s): _____________ 7. Indicate the type of pension plan (check the most appropriate): [ ] defined contribution [ ] defined benefit [ ] combination of defined benefit and defined contribution [ ] financial institution pension plan [ ] multi-employer pension plan [ ] defined contribution [ ] defined benefit 8. Indicate type of Administrator [ ] Employer [ ] Board of Trustees [ ] Entity/Financial Institution (Form 1(a) required) 9. If the Administrator is a Board of trustees, indicate the number of trustees who are representatives of: i) Employer or Employers ____________________ ii) Members or Former Members of the Pension Plan ____________________________________ Private Pensions 81 List the Name of Trustees: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ (If the Board of Trustees exceed five (5) persons, kindly attach the remaining list of names to the application.) All Trustees must complete the Biographical Affidavit. 10. Provide the name of the custodian which holds the pension fund assets: Custodian Name: _________________________________ Permanent Address: _______________________________ Mailing Address (if different from above): _____________ Telephone: ________________ Fax: __________________ Contact Person: __________________________________ Pension Fund Account Number: _____________________ 11. Enter the number of members as of the effective date of the establishment of the plan: ________ male (current members) ________ female (current members) ________ total (current members) ________ male (former and retired members) ________ female (former and retired members) ________ total (former and retired members) 82 Private Pensions 12. Type of organization operated by principal employer (check the most appropriate): [ ] sole proprietorship [ ] partnership [ ] corporation [ ] registered charity [ ] other (provide details below) 13. Main business of the principal employer: _____________ 14. Eligibility for membership (specify the class of employees eligible to join the plan): __________________________ 15. Normal retirement age: ___ Employee contribution rate: __ 16. Employer contribution rate: [ ] employer pays remaining cost (defined benefit plan only) [ ] other: _______________________________________ ______________________________________________ 17. If the plan provides defined benefits, please explain the type of defined benefits provided: [ ] final average earnings over the last _ years [ ] best average earnings over the best _ years (of the last ____ years, if applicable) [ ] career average earnings [ ] flat benefit [ ] other (provide details below): ____________________ Private Pensions 83 18. If the plan provides defined benefits, please provide the benefit formula: _______________________________________________ 19. Does the plan provide inflation protection? [ ] Yes (automatic) [ ] Yes (provided by employer on an ad hoc basis if assets are sufficient) [ ] No If "yes", provide further details below: ________________ _______________________________________________ 20. If the plan provides benefits on a defined contribution basis, does the fund offer investment options to members? [ ] Yes [ ] No If "yes", list the investment options below: _____________ _______________________________________________ 21. If the plan provides benefits on a defined contribution basis, how are investment returns to members calculated? [ ] Rate of return of plan investments [ ] Rate of return of investment options chosen by members [ ] Other (provide details below): _______________________________________________ _______________________________________________ 22. Does the pension plan provide for a draw down account? [ ] Yes [ ] No 84 Private Pensions 23. Are the administrative fees and expenses associated with the Plan paid by the employer or from the pension fund? [ ] Employer [ ] Pension Fund 24. Are the investment fees and expenses associated with the Plan paid by the employer or from the pension fund? [ ] Employer [ ] Pension Fund 25. Attach the following documents to the form: (please tick which documents are attached) [ ] resolution or declaration adopting the plan text [ ] plan text [ ] previous versions of plan text relating to the plan before it was registered (if applicable) [ ] initial valuation report (defined benefit plans only) [ ] statement of investment policy [ ] list of other employers (if the answer to question 2 is “yes”) [ ] list of trustees (if required by question 5) [ ] collective agreement (if the answer to question 9 is “yes”) [ ] trust agreement or insurance contract with the custodian [ ] information booklet [ ] registration fee payable to the Supervisor of Pensions [ ] other documents supporting the plan (provide details below) ______________________________________________ 26. Application fee included? [ ] Yes [ ] No If “no”, please provide explanation: _________________ ______________________________________________ Cheques should be payable to Financial Secretary. Private Pensions 85 DECLARATION I/WE, ______________________________ , hereby apply for registration of the Pension Plan identified below in accordance with the Pensions Act (the “Act”) and the Regulations. I make this application in my capacity as an “Administrator” licensed by the Supervisor of Pension. Attached are true and current copies of the documents that create and support the Pension Plan and the pension fund as well as any other documents required to be submitted under the Act and the Regulations. I DECLARE THAT: 1. The documents submitted with this Form include true and current copies of the documents that create and support the Pension Plan and the pension fund and those documents, as well as all other documents submitted with this application, comply with the Act and the Regulations; 2. I understand that the obligation to ensure that the documents submitted with this Form comply with the Act and the Regulations is the responsibility of the employer/financial institution, and I declare that I have fulfilled that obligation and have complied with the provisions of the Act and the Regulations in making this application for registration. CAP. 30:01. 3. I/WE consent to the Supervisor of Pension to obtain information from any source as permitted by the Laws of Belize or any other jurisdiction for the purpose of verifying the information submitted in support of this application. I declare that I am aware of the obligations under this Act as Administrator establishing the Pension Plan and that the contents of this form and the documents submitted with this form, and my declarations are true to the best of my knowledge and belief. 86 Private Pensions DATED this _____ day of __________________ , 20 ______ (Authorized Signature of Employer/FIPP) (Signature of Witness) (Authorized Signature of Administrator) (Signature of Witness) __________ Private Pensions 87 FORM 3 THE PRIVATE PENSIONS ACT The Private Pensions Regulations APPLICATION FOR REGISTRATION OF A PENSION PLAN AMENDMENT (All questions must be completed except where indicated - please type or print. Please use one form for each pension plan document that is amended.) 1. Plan registration number: __________________________ 2. Plan name: ______________________________________ 3. Employer/financial institution name: _________________ 4. Plan administrator name: ___________________________ 5. Effective date of plan amendment (provide all effective dates, if there is more than one): _______________________________________________ 6. Which document is being amended? [ ] pension plan document (answer questions 8 to 10) [ ] employer participation agreement (answer question 11) [ ] custodial agreement (answer question 12) [ ] statement of investment policy (answer question 13 and 14) [ ] other (provide summary of the amendment below) 7. Has the amendment been disclosed to members? [ ] Yes [ ] No 88 Private Pensions If "yes", attach to this form a copy of the notice. If “no” provide an explanation. 8. What is the date of notice distributed? ________________ 9. Indicate whether the plan text amendment concerns the following (check all that apply): [ ] new plan text [ ] change of employer/financial institution sponsoring plan [ ] change of administrator [ ] change contribution rate [ ] employer [ ] employee [ ] reduction of accrued benefits (defined benefit plan) [ ] reduction of future benefit accrual rate (defined benefit plan) [ ] increase accrued benefits (defined benefit plan) [ ] increase future benefit accrual rate (defined benefit plan) [ ] method of allocating investment returns (defined contribution plan) [ ] provide inflation indexing [ ] add defined benefit or defined contribution provision for future service [ ] defined contribution [ ] defined benefit [ ] remove defined benefit or defined contribution provision for future service [ ] change class of employees eligible to join plan [ ] close plan to new employees Private Pensions 89 [ ] surplus sharing application [ ] plan wind up 10. Has the principal employer or administrator changed? [ ] Yes (Employer name changed) [ ] Yes (New employer/financial institution) [ ] Yes (Administrator name changed) [ ] Yes (New administrator or member of board of trustees) [ ] No If "yes", provide updated information for the principal employer/administrator: Name: _______________________________________________ Contact Person: _______________________________________________ Mailing Address: _______________________________________________ Tel. /Fax: _______________________________________________ 11. Provide a summary of the amendment to the pension plan document. _______________________________________________ _______________________________________________ 12. Has a participating employer been added or deleted? [ ] Deleted [ ] Neither 90 Private Pensions Provide the new/former participating employer’s contact information: Employer Name: ________________________________ Contact Person: _________________________________ Mailing Address: ________________________________ Tel/Fax: _______________________________________ 13. Has the identity of the custodian changed? [ ] Yes [ ] No If "yes”, provide the name of the new custodian which holds the pension fund assets: Custodian Name: ________________________________ Contact Name: __________________________________ Mailing Address: ________________________________ Tel/Fax: _______________________________________ Pension Fund Account Number: ____________________ 14. Indicate whether the statement of investment policy amendment concerns the following (check all that apply): [ ] change of investment manager [ ] change in investment options (defined contribution plan) [ ] investment objectives [ ] diversification [ ] asset mix or investment strategy [ ] risks affecting the investment portfolio [ ] rate of return expectations and expected volatility Private Pensions 91 [ ] criteria for selection of investment managers [ ] liquidity of investments [ ] valuation of investments that are not regularly traded at a public exchange [ ] criteria and process for related party investments 15. Provide a summary of the amendment to the statement of investment policy: _______________________________________________ _______________________________________________ 16. Is the prescribed application fee attached? [ ] Yes [ ] No If “no”, provide an explanation. (Cheques should be payable to Financial Secretary). 92 Private Pensions DECLARATION BY ADMINISTRATOR I, _________________________________ , hereby apply for registration of the amendment or other document identified in this Form in accordance with the Pensions Act (the “Act”) and the Regulations. I make the application in my capacity as the administrator of the: _______________________________ (the “Pension Plan”). Attached is a signed or certified copy of the amendment or other document being submitted. I DECLARE THAT: 1. The document submitted with this Form is a true and current copy, and that this document complies with the Act and the Regulations; 2. I understand that the obligation to ensure that the documents submitted with this Form comply with the Act and the Regulations is the responsibility of the employer/financial institution, and I declare that I have fulfilled that obligation and have complied with the provisions of the Act and the Regulations in making this application for registration. CAP. 30:01. I declare that I am aware of the obligations under the Act as administrator of the Pension Plan and that the contents of this Form and the document submitted with this Form, and my declarations are true to the best of my knowledge and belief. DATED this ____ day of ________________ , 20 ________ . (Authorized Signatory - Administrator) (Witness) __________ Private Pensions 93 FORM 4 THE PRIVATE PENSIONS ACT The Private Pensions Regulations ANNUAL INFORMATION REPORT (All questions must be completed except where indicated - please type or print.) 1. Plan Registration Number: _________________________ 2. Plan Name: _____________________________________ 3. Plan Reporting Period: _______________________________________________ 4. Employer or financial institution information: Employer/Financial Institution: ______________________ Contact Person: __________________________________ Mailing Address: _________________________________ Tel/Fax: ________________________________________ 5. Plan administrator name and address: Administrator Name: ______________________________ Contact Person: __________________________________ Mailing Address: _________________________________ Tel/Fax: ________________________________________ 94 Private Pensions 6. Custodian Name and Address: Custodian Name: ________________________________ Contact Person: _________________________________ Mailing Address: ________________________________ Tel/Fax: _______________________________________ Pension Fund Account Number: ____________________ 7. Location of books or records of plan administrator: (Type “Same”, if same as plan administrator’s address.) ______________________________________________ ______________________________________________ ______________________________________________ 8. Name of collective bargaining agent representing the largest number of members of the pension plan (if applicable): 9. Funding information for the reporting period: _________ employer contributions _________ member contributions _________ member additional voluntary contributions 10. Were any employer contributions overdue during the reporting period, or were any member contributions remitted late? [] Yes [ ] No Private Pensions 95 If “yes”, provide details below, including confirmation of payment of overdue contributions with interest. _______________________________________________ _______________________________________________ 11. Membership information at the end of the reporting period: ____________ male (current members) ____________ female (current members) ____________ total (current members) ____________ male (former and retired members) ____________ female (former and retired members) ____________ total (former and retired members) 12. Annual Information Report Fee Calculation $5 x ____________ total (current and former members) Cheques should be payable to Financial Secretary. 13. Has the administrator reviewed the Statement of Investment Policy since the last Annual Information Report? [ ] Yes [ ] No If “yes”, provide the date of the last review: ___________ 14. Are the plan investments in compliance with the Statement of Investment Policy? [ ] Yes [ ] No If “no”, provide details: ___________________________ _______________________________________________ 96 Private Pensions 15. Have the pension plan and pension fund been administered in compliance with the Pensions Act and Regulations? [ ] Yes [ ] No If “no”, provide details: ___________________________ ______________________________________________ 16. Provide an estimate of the plan administration expenses as a percentage of assets, as disclosed to members on the annual statement: _______________________________________________ _______________________________________________ 17. Provide an estimate of the plan investment expenses as a percentage of assets, as disclosed to members on the annual statement: ______________________________________________ ______________________________________________ DECLARATION: I declare that I am aware of the obligations under the Pensions Act as administrator of the Pension Plan and that the contents of this form and my declarations are true to the best of my knowledge and belief. DATED this ____ day of ______________ , 20 __________. (Authorized Signature) (Witness) (Name of Authorized Signatory) (Name of Witness) (Authorized Signatory- Employer/Financial Institution) (Witness) __________ Private Pensions 97 FORM 5 THE PRIVATE PENSIONS ACT The Private Pensions Regulations COMMENTS AND INSTRUCTIONS SPOUSE’S WAIVER OF PRE-RETIREMENT DEATH BENEFIT This waiver must be completed by the spouse of a pension plan member* when the member wishes to appoint someone other than the spouse as a beneficiary or where the spouse does not wish to receive the mandatory death benefits. In order for the death benefit to go to someone other than the spouse, the spouse must consent and waive his or her right to a death benefit from the pension plan. Under section 26 of the Act, the pre-retirement death benefit is as followsCAP. 30:01. (a) in a defined contribution pension plan, the value of the member’s vested defined contribution account balance, including accumulated additional voluntary contributions, if any; and (b) in a defined benefit pension plan, the actuarial equivalent of the member’s vested pension benefit. Prior to signing this waiver form, the spouse should consider seeking the advice of a legal or financial advisor. * In this Form, the term “member” includes both a member who is currently employed and a former member who has terminated employment but has not commenced a pension. 98 Private Pensions The waiver must be: • completed in its entirety; • signed by the spouse, in the presence of a witness, outside of the immediate presence of the member; and • filed with the administrator of the pension plan. The waiver can be cancelled by the spouse at any time prior to the member’s death. Private Pensions 99 SPOUSE’S WAIVER OF PRE-RETIREMENT DEATH BENEFIT I, _________________________________________________ (print or type full name of spouse) certify that I am the spouse of __________________________ (print or type full name of plan member) who is a member in the following pension plan subject to the provisions of the Pensions Act: __________________________________________________ (print or type full name of pension plan) 1. I understand that I am entitled to a death benefit in the event of the member’s death in accordance with section 26 of the Pensions Act, and that my written consent is required to enable the member to appoint another beneficiary or for the death benefit to go to the estate. 2. I declare that, by signing this waiver and filing it with the administrator of the pension plan– (a) I understand the pre-retirement death benefit will go to a beneficiary appointed by the member or the member’s estate; and (b) I will not receive any pre-retirement death benefit under the pension plan; and (c) I voluntarily surrender my right to a pre- retirement death benefit under the pension plan. 3. I certify that this consent is being signed freely and voluntarily without any compulsion on the part of the member and outside the immediate presence of the member. 100 Private Pensions I sign this consent at _________________________________ this ______ day of ______________________ 20 _____ in the presence of ________________________________________ (print or type name of witness) of ________________________________________________ (address of witness) (Signature of witness) (Spouse’s signature) __________ Private Pensions 101 FORM 6 THE PRIVATE PENSIONS ACT The Private Pensions Regulations COMMENTS AND INSTRUCTIONS SPOUSE’S WAIVER OF SURVIVOR PENSION This waiver must be completed by the spouse of a pension plan member† when the spouse does not wish to receive the mandatory survivor pension upon the death of the member after the pension commences. In order for the member to elect a form of pension that does not include a spousal survivor pension, the spouse must consent and waive his or her right to a survivor pension from the pension plan. Under section 27 of the Pensions Act, a spouse is entitled to a survivor pension equivalent to 60% of the pension payable during the member’s lifetime. Prior to signing this waiver form, the spouse should consider seeking the advice of a legal or financial advisor. The waiver must be: • completed in its entirety; • signed by the spouse; in the presence of a witness, outside of the immediate presence of the member; and • filed with the administrator of the pension plan. The waiver can be cancelled by the spouse at any time prior to the commencement of the pension. † In this Form, the term “member” includes both a member who is currently employed and a former member who has terminated employment but has not commenced a pension. 102 Private Pensions SPOUSE’S WAIVER OF SURVIVOR PENSION I, ________________________________________________ (print or type full name of spouse) certify that I am the spouse of __________________________ (print or type full name of plan member) who is a member in the following pension plan subject to the provisions of the Pensions Act: _________________________________________________ (print or type full name of pension plan) 4. I understand that, in accordance with section 27 of the Pensions Act, the pension paid to the member from the pension plan must be paid as a joint and survivor pension if we are spouses on the date that the payment of the pension commences. 5. I further understand that I am entitled to a survivor pension equal to 60% of the pension payable during the member’s lifetime in the event of the member’s death and that my written consent is required to enable the member to choose to receive a type of pension that does not include a survivor pension. 6. I declare that, by signing this waiver and filing it with the pension plan administrator– (a) I voluntarily surrender my right to a survivor pension under the pension plan; and (b) I will not receive a pension after the member’s death. 7. I certify that this consent is being signed freely and voluntarily without any compulsion on the part of the member and outside the immediate presence of the member. Private Pensions 103 I sign this consent at__________________________________ this ________ day of ________________ 20 ________ in the presence of _________________________________________ (print or type name of witness) of ________________________________________________ (address of witness) (Signature of witness) (Spouse’s signature) __________ 104 Private Pensions FORM 7 THE PRIVATE PENSIONS ACT The Private Pensions Regulations COMMENTS AND INSTRUCTIONS SPOUSE’S CONSENT TO TRANSFER TO A DRAW DOWN ACCOUNT This consent must be completed by the spouse of a former member of a pension plan when the former member wishes to transfer his or her pension benefit entitlement to a draw down account. In order for the transfer to occur, the spouse must consent to the transfer and waive his or her right to a survivor pension from the pension plan. A draw down account is subject to an annual limit on the amount of income that may be withdrawn. The former member could withdraw the entire balance in the draw down account, leaving the spouse with no pension payable on the death of the former member. The spouse may still receive the balance of the draw down account after the death of the former member. Prior to signing this consent form, the spouse should consider seeking the advice of a legal or financial advisor. The consent must be: • completed in its entirety; • signed by the spouse, in the presence of a witness, outside of the immediate presence of the former member; and • filed with the administrator of the pension plan. The consent cannot be cancelled by the spouse. Private Pensions 105 SPOUSE’S CONSENT TO TRANSFER TO A DRAW DOWN ACCOUNT I, _________________________________________________ (print or type full name of spouse) certify that I am the spouse of __________________________________________________ (print or type full name of former member) who is a former member in the following pension plan subject to the provisions of the Pensions Act: ____________________________ and who wishes to transfer (print or type full name of pension plan) the following amount to a draw down account: _____________ (print or type amount to be transferred) 1. I understand that the former member wants to transfer his pension benefits in the pension plan to a draw down account in accordance with section 42 of the Pensions Act, and that my written consent is required to enable the former member to make the transfer. 2. I declare that, by signing this consent and filing it with the pension fund– (a) I am authorizing the former member to manage the money in the account, subject to the maximum annual withdrawal payment permitted by the Supervisor of Pensions; (b) I understand that there is no survivor pension provided under the draw down account and I am authorizing the former member to withdraw part or all of the balance of the money in the account; and 106 Private Pensions (c) I voluntarily surrender my right to a survivor pension under the pension plan. 3. I certify that this consent is being signed freely and voluntarily without any compulsion on the part of the former member and outside the immediate presence of the former member. I sign this consent at ______________ this ___________ day of _______________________ 20 ________ in the presence of (print or type name of witness) of ________________________________________________ (address of witness) (Signature of witness) (Spouse’s signature) __________ Private Pensions 107 SCHEDULE II [regulation 2] Fee Schedule Application Fee Administrator of Pension Plans, where administrator is an entity or financial institution .............. $500 Administrator of Financial Institution of Pension Plan .... $500 Registration Fee Registration of a Pension Plan .......................................... $100 Registration of an Amendment to a Pension Plan ............ $100 Annual Licence Fee Annual Licence Fee - Administrator (entity/financial institution) ............................................. $500 Annual Licence Fee of Financial Institution Pension Plan Administrator .............................................. $500 Annual Assessment Fee of Pension Plans Minimum fee of $100 or fee basis per member as follows, whichever greater Per member ....................................................................... $ 10 Per former member ........................................................... $ 5 Inspection Fees ................................................................. $ 10 Photocopies ............................................................. $1 per page __________