INDIVIDUAL PENSION PLAN (IPP)
FUNDING INFORMATION SHEET

Company name:                                                                                                           
Pension plan member name:                                                                                         

Please indicate the funding arrangement for the pension plan (choice of A, B or C).
Please note that the client is responsible for selecting and executing the IPP's funding arrangement.

A.  Deposit Administration Contract With An Insurance Company
Name of Insurance Company:                                                           ____  _
Contact Person: ______________________
Address: ___________________________
            ___________________________
            ___________________________
Postal Code: ________________________
Phone Number: ______________________

B.  Trust Agreement with a Corporate Trustee
Name of Trust Company:                                                              
Contact Person: ______________________
Address: ___________________________
            ___________________________
            ___________________________
Postal Code: ________________________
Phone Number: ______________________

C.   Trust Agreement with Three Individual Trustees

Provide information below on the three Individual Trustees:

Individual Trustee Information

Note: Any investments held under the pension trust should be held under the account name “Trustees of Pension Plan” – For example, “Trustees of ABC Ltd. Pension Plan For John Doe”
_______________________________________
* Please indicate whether the trustee is independent of the Company (Yes or No).  Being independent means the individual is not a shareholder / partner / proprietor or employee of the Company.  There must be at least one trustee who is independent.

** Please use residential address for this purpose.  Canada Revenue Agency requires the trustee’s residential address to confirm that trustee is a Canadian residents.