
INDIVIDUAL PENSION PLAN (IPP)
DATA SHEET – YEAR 2011
Company Information
Full legal name:
Address (including postal code):
Telephone number:
Fax number:
Name of contact: Title:
Date of incorporation (DD/MM/YYYY):
Fiscal year-end:
Nature of Business:
CRA Employer Remittance Account Number [1] :
Employee Information
Name:
Gender: Male/Female
Connected? [2] Yes/No
S.I.N.:
Province of employment:
Birthdate (DD/MM/YYYY):
Hire Date (DD/MM/YYYY):
Address (incl. postal code):
Phone:
Fax:
Email:
Gross earnings reported on T4:
Year Amount
2011 (expected):
2010:
2009:
2008:
2007:
2006:
2005:
2004:
2003:
2002:
2001:
2000:
1999:
1998:
1997:
1996:
1995:
1994:
1993:
1992:
1991:
1990*:
* If 1990 earned income for RRSP purposes is different from T-4 earnings paid by Company,
please indicate amount here _____________.
Unused RRSP Contribution Room (prior to Dec. 31, 2010):
RRSP Balance (Market Value):
Accountant Information
Name:
Company Name:
Address (incl. postal code):
Phone:
Fax:
Email:
Financial Advisor Information
Name:
Company Name:
Address (incl. postal code):
Phone:
Fax:
Email: