h - OREC

Ottawa Renewable Energy Co-op Subscription Form
To: Ottawa Renewable Energy Co-operative (the ‘Co-operative’)
The undersigned subscribes for a total of ____________ (minimum of 5 outside of an RRSP, 10
inside an RRSP) Class A Preference Shares (“Shares”) of the Co-operative, at a price of $500.00
per Share. Enclosed herewith is a cheque or money order in the amount of $________ payable
to “Ottawa Renewable Energy Co-operative,” representing payment in full for the Shares.
1. The undersigned acknowledges that the undersigned:
(a)
is aware that the Shares are being sold under an Offering Statement and acknowledges
that the undersigned is not acquiring the Shares as a result of any information about the affairs
of the Co-operative that is not generally known to the public;
(b)
has received a copy of the Co-operative's Offering Statement as prepared in accordance
with the provisions of the Co-operative Corporations Act, R.S.O. 1990, CHAPTER C.35 with regard
to the sale of the Shares and further acknowledges that the undersigned is aware of and
understands its contents including the "Risk Factors" section contained therein;
(c)
has received and obtained all of the information regarding the Co-operative that the
undersigned requires prior to making this subscription and that the undersigned’s subscription
has not been solicited in any way contrary to the provisions of the Co-operative Corporations Act
and the regulations thereto;
(d)
understands that subscription proceeds will be held by the Trustee, in a trust account of
the undersigned until the minimum offering of 200 Shares is achieved. After the minimum
offering of 200 Shares has been achieved, and the Shares issued and registered therefore,
subscription funds will be available for investment upon request by the Co-operative;
(e)
understands that if the minimum offering of 200 Shares has not been achieved by July
28, 2014, the offering will be withdrawn and the proceeds of subscriptions will be returned to
investors without interest;
(f)
understands that this subscription is given for valuable consideration and shall not be
withdrawn or revoked by the undersigned after midnight of the second day after acceptance.
The acceptance of this subscription shall be effective upon delivery to the Co-operative and the
tender of the full subscription price by cheque or money order;
(g)
understands that, if Preference Shares are purchased through an RRSP, currently there
is no RRIF option available to convert the shares when members turn 71; therefore the par value
of the shares and any dividends accrued in the RRSP will need to be declared as income that
year; and
(h) understands that, if the Preference Shares are purchased through an RRSP, currently the
shares are not eligible for the First Time Homebuyers Program.
2. The undersigned hereby declares, represents and warrants that:
(a)
the undersigned is purchasing the Shares as principal;
(b)
the undersigned has attained the age of 19 years and is a resident of Ontario;
(c)
the undersigned is a member of the Co-operative;
(d)
by virtue of the undersigned’s investment experience or by virtue of the undersigned’s
consultation with or advice from professional advisors, the undersigned is in a position to
evaluate the prospective investment on the basis of the Offering Statement and has determined
that the investment in the Shares is compatible with the undersigned’s investment objectives; and
(e)
the undersigned is not a resident of the United States of America or any place subject to
the jurisdiction thereof and is not acting directly or indirectly for any person who is resident of
the United States of America or any place subject to the jurisdiction thereof.
The said Shares are to be registered as follows:
Full Name (please print):
_______________________________________________
Social Insurance Number:
______ - ______ - ______
Street Address:
_______________________________________________
City and Province:
_______________________________________________
Postal Code:
_______________________________________________
Dated this __________ day of ___________ , 201__.
Signature of
Subscriber____________________________ Witness ___________________________
Note: The accepted subscription, share certificate and other documentation will be mailed to
the subscriber at the address noted above. The Shares will be registered in the manner in which
the subscriber’s name appears above. Any change in the subscriber’s address will only be
effective on receipt of written notice thereof by the Co-operative.
Receipt and acceptance of the foregoing subscription and payment of the subscription price is
acknowledged
Per:
_________________________________________________________________
192 Rodney Crescent
Ottawa, Ontario K1H 5J9
About Investing in OREC through a Self-Directed RRSP
There are two ways to invest in OREC shares under a self-directed RRSP; a) as new contributions
or b) as a transfer in from an existing RRSP.
The Canadian Worker Co-operative Federation (CWCF) manages self-directed RRSP accounts for
OREC members. CWCF is registered with the Canadian Revenue Agency. Their website is
www.canadianworker.coop. The CWCF charges an annual fee of $50 and a withdrawal fee of
$75. To make a withdrawal or for any other questions, contact:
Pamela Farrow, RRSP Program Manager
P.O. Box 89, Grand Pre, NS, B0P 1M0
tel 902-697-2470 fax 902-697-2524
email [email protected]
When a withdrawal is made, CWCF will mail you a cheque for the amount requested less the
$75 withdrawal fee. The annual fee, which is due in early December, is charged to OREC. OREC
will pay the CWCF fee and then deduct the cost from investors’ annual dividend. OREC will pay
dividends into the investor’s RRSP account. OREC members may be able to request dividend
payouts as new OREC shares.
Note that the CWCF does not have a RRIF program. At the age of 71, investors will have to
withdraw their OREC investment from their self-directed RRSP and declare it as income. Also
note that the shares are currently not eligible for the First Time Home Buyers Program.
Steps to Investing Through and RRSP
Fill out forms 1-7 to open an RRSP account for OREC shares. Add form 8 if you are transferring
funds. If you have an existing RRSP account with OREC, skip forms 1-4. When filling out the
forms, note that you are the annuitant. We apologize for the administrative burden.
Please mail the completed forms to:
OREC
192 Rodney Cres.
Ottawa, ON K1H 5J9.
1. Declaration of Trust. No signature is required. You must read the document.
2. RRSP Application Form. Leave the “Contract #” in the top right blank. The “Agent Name” is
Johan Hamels 613-748-3001. Make sure to enter your birth date.
3. Designation of Beneficiary Form. Leave the “Client Contract #” blank. Put a check mark
beside “First Designation” (add). Ensure a witness signs.
4. Fee Schedule. Put your name on the top line. Leave the “Contract #” blank. Sign and Date.
5. Payment Authorization Form. Put your name on the top line. Enter “Ottawa Renewable
Energy Co-operative Inc.” on the second line. Sign and Date.
6. Deposit Form. Leave the “Contract #” blank. If this is a new contribution to an RRSP, put a
check mark beside “Contribution In-Kind”. If it is a Transfer from an existing RRSP, check
the appropriate transfer option. In the “Security Deposits” box enter “OREC preference
shares” and the value. Sign and Date. Johan Hamels is the agent 613-748-3001.
7. Shares Annuitant Declaration. This form is to declare that you own less than 10% of the
issued shares. No investor at OREC falls into this category. Put your name on the top
line. Leave the “Plan #” blank. Enter the number of shares purchased (the shares cost $500
each) and the value of the purchase. Sign and date. Get a witness to sign.
To Transfer In RRSPs
8. Direct Transfer-In Form. Contact your institution to generate the cash or make it very clear
on the form which holdings are to be sold to generate the cash. Fill in your name, SIN,
phone number, and address. Include the address and phone number of the institution the
investment is transferring from. Fill in the “Contract or Plan #” with the information from
the account you are transferring from. Leave the “Deposit #,” and the “Maturity Date”
blank. Lease Part II blank. Please note that it takes approximately 3-4 weeks for the cash to
arrive.
192 Rodney Crescent
Ottawa, Ontario K1H 5J9
CANADIAN WORKER CO-OPERATIVE FEDERATION
SELF-DIRECTED RETIREMENT SAVINGS PLAN
DECLARATION OF TRUST
We, Concentra Trust, declare that we accept the trust created between us and the Annuitant when the application was signed. The following are the terms of this trust:
1.
Definitions
The following definitions apply:
“Contributor”
The individual, either you or your spouse, who made a contribution
to The Plan.
“Contribution”
Any amount paid or qualified investment deposited in your Plan.
“Income Tax Act” Income Tax Act (Canada), and regulations thereto, as amended
from time to time.
“Plan”
The Canadian Worker Co-operative Federation Self-Directed
Retirement Savings Plan consisting of the Application and this
Declaration of Trust and the addendum or addenda thereto, where
applicable.
“Plan Maturity”
The date you eventually select for commencement of retirement
income from the Plan. (This date must not be later than the
maturity date provided in the Income Tax Act.)
“Spouse”
As recognized in the Income Tax Act for the purposes of registered
retirement savings plans and, where applicable, incorporates the
meaning of the term “common-law partner” as set out in Subsection 248(1) of the Income Tax Act.
“Trustee”
Concentra Trust
2.
Registration
We will apply for registration of your Plan as required by the Income Tax Act.
3.
Contributions
We will hold all contributions made to your Plan, and any income earned on these
contributions, as outlined in this Declaration and as required by the Income Tax Act. No
contributions may be made after the Plan Maturity.
4.
Record Keeping
We will record the details of all contributions and transactions relating to your Plan. We
will supply you with a statement of these details at least annually.
5.
Income Tax Receipts
We will provide the contributor with a receipt or receipts, suitable for income tax filing
purposes, for all eligible contributions.
6.
Refund of Contributions
Upon receipt of your written application, and the written application of your spouse if
your spouse was the contributor to your Plan, we will refund to the taxpayer the
amount determined in accordance with Paragraph 146(2)(c.1) of the Income Tax Act.
7.
Investment
All contributions and other assets or amounts properly transferred into your Plan will be
deposited and invested as directed by the Annuitant. The Annuitant shall be permitted
to hold investments in Cooperative Corporation Shares as defined in subsection
4900(12) of the Income Tax Act, CEDIF shares issued under the Nova Scotia Securities
Act, and other assets and investments, which are:
a. authorized under the Income Tax Act; and
b. acceptable to the Trustee.
We reserve the right to refuse, hold or accept certain investments even though they
may be qualified investments under the Income Tax Act.
8.
Retirement Income
You must advise us in writing, at least 90 days prior to your Plan Maturity, of the type
of retirement income you elect to receive from the proceeds of your Plan. You may
choose to receive income from any one of, or any combination of, a life annuity, a fixed
term annuity providing benefits for a term of years equal to 90 minus the age in whole
years of the annuitant at the maturity of the plan (or the annuitant’s spouse if the
spouse is younger and the annuitant so elects to use the spouse’s age), a registered
retirement income fund or other retirement income option that may be provided for in
the Income Tax Act. If the retirement income you choose to receive is an annuity, it
must meet the following conditions:
a. It must be paid out in a single lump sum if it becomes payable to someone other
than your spouse upon or after your death.
b. It must be paid in equal annual or more frequent periodic payments until such time
as you fully or partially commute this retirement income and, where such
commutation is partial, equal annual or more frequent periodic payments thereafter.
c. It must not provide for any increase in the amount of the periodic payments as a
result of your death where payments are to continue to your spouse following your
death.
d. It may not be assigned in whole or in part.
If you have not advised us in writing, prior to the maturity date provided in the Income
Tax Act, of your selection of a retirement income the proceeds of your Plan will be
transferred to a Registered Retirement Income Fund trusteed by us. If the funds held in
your Plan at the Plan Maturity are not sufficient to produce a retirement income of
greater than $250.00 per annum the funds in your Plan will be paid to you as a single
lump sum in the year following Plan Maturity.
9.
Beneficiary Designation
You may designate a beneficiary, in those provinces where the law so permits, to
receive the proceeds of your Plan in the event of your death prior to your Plan Maturity.
Details of our requirements for making, changing or revoking such a designation are
available from the office of the Agent.
10. Death
In the event of your death prior to the Plan Maturity, we will, once we have received
the documentation we require, pay or transfer the Plan proceeds, less required income
500-038 Cdn. Worker Co-op Fed (RSP Bilingual) (11/07)
tax deductions, to your designated beneficiary and notify your estate representative of
any resulting tax liability. When we have made the payment to your designated
beneficiary, we will be considered as fully discharged from any further liability with
respect to your Plan. In instances where you have not designated a beneficiary, as
explained in Clause 9 of this Declaration, the proceeds of your Plan will be paid or
transferred, less required income tax deductions, to your estate.
11. Your Responsibilities
It is your responsibility to ensure, that:
a. the contributions to the Plan do not exceed the allowable maximum under the
Income Tax Act;
b. all assets acquired by the Plan are qualified investments for a Registered Retirement
Savings Plan;
c. we are advised, in writing, of any changes in your address;
d. your birthdate as recorded on your application is accurate;
e. you will eventually elect, as spelled out by Clause 8 of this Declaration, the type of
retirement income you choose to receive.
12. Restriction on Trustee
We cannot give you or any person related to you any benefit or advantage if the benefit
or advantage is conditional upon the existence of your Plan.
13. Amendments
We may from time to time amend your Plan by giving you notice in writing on such
change. Any amendment cannot, however, be contrary to the provisions of the Income
Tax Act.
In the event of changes to the Income Tax Act or any pension legislation governing
your plan, your Plan will be considered to have been amended to conform to such
changes effective the date such changes come into force.
14. Notices
Any notices given to us by you under this Plan shall be sufficiently given if mailed,
postage prepaid by you, to any of our offices and shall be deemed to have been given
on the day that such notice is received by us. Any notices given by us to you shall be
sufficiently given if mailed, postage prepaid by us, to you at your last address supplied
by you and shall be deemed to have been given on the day of mailing.
15. Limits of Our Liability
We will not provide any investment advice regarding any of the assets held or acquired
by the Plan and shall act solely on your written instructions or those of your authorized
agent. We shall not be responsible for any loss or damage suffered or incurred by your
Plan, by you or by any beneficiary designated by you, unless caused by or resulting
from our dishonesty, negligence, wilful misconduct or lack of good faith.
16. Withdrawals
You may make withdrawals from your Plan, subject to the following conditions:
a. we will withhold taxes from any withdrawals in such amounts as required by the
Income Tax Act from time to time;
b. withdrawals must be declared by you as income for the taxation year of receipt.
17. Transfers
The Plan may be amended to permit the payment or transfer, on behalf of the
Annuitant, of any funds as allowed by the Income Tax Act. We may, at our discretion,
charge a fee for each transfer out of the plan.
18. Trustees’ Financial Conditions
We shall be entitled to:
a. pay all costs, charges, and/or overdrafts incurred in connection with the Plan out of
the plan;
b. pay all brokerage fees, commissions and other relevant costs, if any, from the assets
of this Plan as they are incurred;
c. receive remuneration for our services as Trustee in each year and reimbursement of
proper disbursements made in accord with the current fee schedule in effect
between us;
d. sell investments of the Plan in order to realize sufficient monies therefrom to pay the
above costs and expenses, if the said costs and/ or expenses are not paid by the
Annuitant within sixty (60) days of the billing thereof, and after having given the
Annuitant fifteen (15) days written notice in this regard. You shall be liable to us for
all such costs, charges, remuneration and/or overdrafts to the extent that the Plan
assets are not sufficient to cover the same. We shall not be required to consult with
you when determining which of the plan assets are to be sold and shall not be liable
for any loss resulting therefrom.
19. Other Conditions
While this Plan continues to be a Retirement Savings Plan under the provisions of the
Income Tax Act, it shall constitute an inter vivos trust. Neither the Plan nor the assets
of the Plan can be used as security for a loan.
20. Resignation of Trustee
We may resign at any time by delivering sixty (60) days notice of its resignation to the
Annuitant. In the event of our resignation, you shall appoint a successor trustee or
trustees who shall be acceptable to us. We shall deliver the property comprised of the
investments within the Plan and the records relating thereto, and shall execute such
deeds and assurances and do such things as may be requisite in order to ensure the
continued and uninterrupted operation of the Plan. Should you neglect or refuse to
appoint a successor trustee or trustees who shall be acceptable to us, we reserve the
right to transfer assets in specie to you as a withdrawal from the Plan.
21. Ultimate Responsibility
We have entered into an Agency Agreement with Canadian Worker Co-operative
Federation named in the Plan, which provides that Canadian Worker Co-operative
Federation (or any of its duly authorized representatives) acts as our Agent for the
purpose of administration of this Plan. However, we are ultimately responsible for the
administration of the Plan.
RÉGIME D’ÉPARGNE-RETRAITE AUTOGÉRÉ
CANADIAN WORKER CO-OPERATIVE FEDERATION
DECLARATION DE FIDUCIE
Nous, La Société de Fiducie Concentra, acceptons la déclaration de fiducie (dont les dispositions sont énoncées ci-après) conclue entre nous et le rentier au moment de la signature de la Demande de régime
d’épargne-retraite.
1
Définitions
Les définitions qui suivent s’appliquent à la présente Déclaration de fiducie.
“Conjoint”
Tel que reconnu comme époux dans la Loi de l’impôt sur le revenu (Canada)
aux fins des régimes enregistrés d’épargne-retraite. Le cas échéant, ce terme
incorpore la signification de “conjoint de fait” tel que mentionné dans au
paragraphe 248 (1) de la Loi de l’impôt sur le revenu (Canada).
Advenant votre décès avant l’échéance du Régime, nous verserons ou transférerons, dès
réception des documents nécessaires, la valeur du Régime à votre bénéficiaire désigné. Nous
retiendrons toutefois sur cette valeur l’impôt exigible sur le revenu et aviserons votre
représentant successoral des obligations fiscales en découlant.
Dès le versement de cette valeur à votre bénéficiaire désigné, nous serons considérés comme
ayant acquitté toutes nos obligations en vertu de votre Régime.
“Cotisant”
Personne qui cotise au régime, il peut s’agir de vous ou de votre conjoint.
“Cotisation”
Somme d’argent ou investissements admissibles versés dans votre régime.
Si aucun bénéficiaire n’a été désigné, aux termes de l’article 9 de la présente Déclaration, la
valeur de votre Régime, moins l’impôt exigible sur le revenu, sera versée ou transférée sous
forme de somme unique à votre succession.
“Échéance du
régime”
Date à laquelle débute le versement d e la rente e retraite en vertu du
régime. Vous déterminez vous-même cette date (qui ne doit toutefois pas
survenir après la date d’échéance stipulée dans la Loi de l’impôt sur le revenu
(Canada).
“Fiduciaire”
La Société de Fiducie Concentra
11
a. les cotisations versées à votre Régime ne dépassent pas la limite permise par la Loi de
l’impôt sur le revenu;
b. tous les placements acquis par le Régime sont des placements admissibles au titre d’un
Régime d’épargne-retraite;
c. vous nous avez avisé, par écrit, de tout changement d’adresse;
d. la date de naissance indiquuée dans votre Demande est exacte;
e. vous choisirez éventuellement, tel qu’il est énoncé à l’article 8 de la présente Déclaration de
fiducie, le type de revenu de retraite que vous souhaitez recevoir.
“Loi de l’impôt La Loi de l’impôt sur le revenu (Canada) et ses règlements d’application,
sur le revenu
ainsi que les modifications qui leur sont apportées.
“Régime”
Le Régime d’épargne-retraite du autogéré Canadian Worker Co-operative
Federation regroupant la demande et la Déclaration de fiducie ainsi que les
addenda, le cas échéant.
2
Enregistrement
Nous nous chargerons de faire la demande d’enregistrement de votre Régime conformément
aux dispositions de la Loi de l’impôt sur le revenu.
3
Cotisations
Conformément aux dispositions de la présente Déclaration et de la Loi de l’impôt sur le revenu,
nous conserverons, toutes les cotisations versées dans votre Régime ainsi que le revenu gagné.
Il est interdit de verser des cotisations au Régime après son échéance.
4
Tenue des registres
Nous consignerons par écrit tous les détails concernant les transactions et les cotisations
versées dans votre Régime. Nous vous ferons parvenir un relevé faisant état de ces détails au
moins une fois par année.
5
Reçus d’impôt
Nous remettrons au cotisant le ou les reçus aux fins de l’impôt relativement à l toutes les
cotisations admissibles.
6
Remboursement des cotisations
Dès réception de votre demande écrite, et de celle de votre conjoint s’il était le cotisant à votre
Régime, nous rembourserons au contribuable le montant calculé conformément à l’alinéa
146(2)(c.1) de la Loi de l’impôt sur le revenu.
7
Placement
Toutes les cotisations et les autres actifs ou montants dûment transférés dans votre Régime
seront déposés ou investis selon les directives du cotisant. Le cotisant est autorisé à conserver
les placements en actions dans une coopérative telles que définies par paragraphe 4900(12) de
la Loi de l’impôt sur le revenu, des actions dans un CEDIF émies par la Loi sur les valeurs
mobilières de la Nouvelle-écosse, et les autres biens et placements, qui :
12
Restriction s’appliquant au fiduciaire
Il nous est interdit de vous accorder ou d’accorder à une personnne avec laquelle vous avez un
lien de dépendance un avantage ou un bénéfice qui dépende de l’existence de votre
Régime.
13
Modifications
Nous nous réservons le droit de modifier votre Régime, de temps à autre, en vous donnant par
écrit un préavis à l’égard de cette modification. Toute modification apportée au Régime ne
saurait toutefois être non conforme aux dispositions de la Loi de l’impôt sur le revenu.
En cas de modifications à la Loi de l’impôt sur le revenu ou à n’importe qu’elle loi régissant
votre Régime, votre Régime sera censé avoir été modifié en conséquence à compter de la date
d’entrée en vigueur des modifications.
14
Avis
Les avis que vous nous donnerez en vertu du Régime seront réputés nous avoir été donnés en
bonne et due forme s’ils sont transmis par courrier , dûment affranchis, à l’un de nos bureaux.
Ces avis seront considérés comme ayant été donnés le jour de leur réception à nos bureaux.
Les avis que nous vous donnerons seront réputés vous avoir été donnés en bonne et due forme
s’ils sont transmis par courrier , dûment affranchis, à la dernière adresse que vous nous aurez
indiquée. Ces avis seront censés vous avoir été donnés le jour de leur mise à la poste.
15
Limite de responsabilité
Nous ne fournirons aucun conseil en placement à l’égard des actifs détenus dans le Régime ou
qui ont été acquis par celui-ci. Nous agirons uniquement conformément à vos instructions
écrites ou à celles de votre mandataire. Nous ne sommes pas responsables de toute perte ou
de tout dommage subi ou encouru par votre Régime, vous même ou le bénéficiaire que vous
avez désigné, à moins qu’une telle perte ou un tel dommage ne soit le résultat de notre
malhonnêteté, négligence, faute intentionnelle ou mauvaise foi.
16
Retraits
Vous pouvez retirer des fonds de votre Régime, sous réserve des conditions suivantes :
a. sont conformes à la Loi de l’impôt sur le revenu; et
b. sont acceptés par les Fiduciaires.
a. les retraits feront l’objet de retenues d’impôt à la source selon le montant exigé par la Loi de
l’impôt sur le revenu,de temps à autre;
b. vous devrez déclarer les sommes que vous retirez du Régime à titre de revenu pour l’année
d’imposition en cours
Nous nous réservons le droit de refuser de conserver ou d’accepter certains placements même
s’il s’agit de placements admissibles au titre de la Loi de l’impôt sur le revenu.
8
Revenu de retraite
Vous devez nous informer par écrit, au moins 90 jours avant l’échéance du Régime, du type de
revenu de retraite que vous choisissez de vous constituer avec la valeur du Régime. Le revenu
peut provenir d’un des éléments suivants ou d’une combinaison de ceux-ci: une rente viagère;
une rente à échéance fixe payable pour un nombre d’années égal à 90 moins l’âge du rentier,
en années accomplies, à l’échéance du Régime (ou l’âge du conjoint, si le conjoint est plus
jeune que le rentier et que celui-ci en décide ainsi); un fonds enregistré de revenu de retraite
ou tout autre revenu de retraite prévu par la Loi de l’impôt sur le revenu. Si le revenu de
retraite que vous choisissez de recevoir est une rente, elle doit remplir les conditions suivantes:
a. Elle doit être versée en une somme unique si elle devient payable à une autre personne que
votre conjoint après votre décès.
b. Elle doit pouvoir être payable en versements périodiques égaux, annuellement ou plus
fréquemment, jusqu’à la conversion totale ou partielle du revenu de retraite et en cas de
conversion partielle, la rente sera payable en paiements périodiques égaux, annuellement
ou plus fréquemment par la suite.
c. S’il s’agit d’une rente réversible, les paiements périodiques faits à votre conjoint ne doivent
pas augmenter par suite de votre décès.
d. Elle ne peut être cédé en totalité ou en partie.
Si vous omettez de nous informer par écrit, avant la date d’échéance stipulée dans la Loi de
l’impôt sur le revenu, de votre choix de revenu de retraite, nous virerons la valeur de votre
Régime à un fonds enregistré de revenu de retraite dont nous serons les fiduciaires. Si les
fonds détenus dans votre Régime à son échéance sont insuffisants pour constituer un revenu de
retraite supérieur à 250 $ par année, ces fonds vous seront versés en une somme unique au
cours de l’année suivant l’échéance du Régime.
9
Désignation du bénéficiaire
Dans les provinces ou la loi le permet, vous pouvez, désigner un bénéficiaire pour recevoir la
valeur de votre Régime advenant votre décès avant son échéance. Vous pouvez obtenir tous
les renseignements voulus sur l’établissement , la modification ou la révocation d’une telle
désignation à nos bureaux.
10
Décès
Advenant votre décès avant l’échéance du Régime, nous verserons ou transférerons, dès
réception des documents nécessaires, la valeur du Régime à votre bénéficiaire désigné. Nous
retiendrons toutefois sur cette valeur l’impôt exigible sur le revenu et aviserons votre
représentant successoral des obligations fiscales en découlant Régime
Dès le versement de cette valeur à votre bénéficiaire désigné, nous serons considérés comme
ayant acquitté toutes nos obligations en vertu de votre
500-038 Cdn. Worker Co-op Fed (RSP Bilingual) (11/07)
Vos responsabilités
Vous êtes tenu de vous assurer que:
17
Transferts
Il est possible de modifier le Régime pour permettre le paiement ou le transfert des fonds selon
ce qui est permis par la Loi de l’impôt sur le revenu. Nous nous réservons le droit d’imputer
des frais pour chaque transfert hors du Régime .
18
Situation financière du fiduciaire
Nous pouvons:
a. payer tous les frais, payments ou découverts necessaire de votre Régime
b. payer tous les frais d’agents, les commissions et les autre charges rélévants à les
placements dans votre Régime.
c. recevoir rémunération chaque année pour notre obligations comme Fiduciaire et pour les
remboursements versée dans la liste officielle des taux.
d. si vous ne payez pas les frais ou remboursements susmentionné dans 60 jours de notre
avis, nous pouvous vendre les placements dans votre Régime, aprex vous donnez une avis
par ecrit il y a quinze (15) jours. Vous devez nous rembourses tous les frais, rémunérations
et/ou découverts si les placements dans votre Régime ne suffire pour le payer. Nous ne
servons pas tenus responsibles de vous consulter pour déterminer quelles biens de vendre
et si les placements sont vendre à perte.
19
Autres modalités
Bien que ce Régime demeure un régime d’epargne-retraite au titre de la Loi de l’impôt sur le
revenu, il représente une fiducie entre vifs. Il est interdit d’utiliser le Régime ou les éléments
d’actif du Régime à titre de garantie pour un prêt.
20
Démission du fiduciaire
Nous nous réservons le droit de démissionner en tout temps en donnant au rentier un avis écrit
de soixante (60) jours. Advenant notre démission, vous devrez nommer un fiduciaire suppléant
ou des fiduciaires suppléants que nous accepterons. Nous remettrons les biens du Régime
(incluant les placements) et tous les registres y afférents et nous signerons les actes et
prendrons les mesures nécessaires afin d’assurer l’exploitation continue et ininterrompue du
Régime. Si vous omettez de désigner un fiduciaire suppléant ou des fiduciaires suppléants qui
nous semblent acceptables ou si vous refusez de le faire, nous nous réservons le droit de faire
un transfert en nature des actifs à votre intention en tant que retrait du Régime.
21
Responsabilité ultime
Nous avons conclu une entente de représentation avec Canadian Worker Co-operative
Federation désigné dans le Régime. Cette entente stipule que Canadian Worker Co-operative
Federation (ou un de ses mandataires dûment autorisés) agira comme notre représentant aux
fins de l’administration du Régime. Toutefois, la responsabilité ultime de l’administration du
Régime nous incombe
Self-Directed Retirement Savings Plan - APPLICATION
Canadian Worker
Co-operative Federation
Régime d’épargne-retraite autogéré
Contract Number/Numéro de contrat
Annuitant/Rentier
Name/Nom (Last name, first name/Nom de famille, prenom)
SIN/Numéro d’assurance sociale
Address/Adresse
Birthdate/Date de Naissance
MM/MM
DD/J
YYYY/AAAA
Postal Code/
Code Postal
Telephone/Téléphone (Residence/Résidence) Telephone/Téléphone (Business/Bureau)
Are you a resident of Canada?
Y - Yes/Oui
Êtes vous résident du Canada?
N - No/Non
Fax Number/Numéro télécopie
Pension Lock-In? Attach agreement/veuillez attacher le contrat.
Fonds de retraite immobilisés?
____________________________
Pension Jurisdiction/Juridiction
Contributor/Cotisant
Complete only if this deposit is being made by and claimed as a deduction by your spouse.
Y - Yes/Oui
N - No/Non
Indiquez si la cotisation doit étre versée par votre conjoint. Dans l’affirmative, inscrivez son
nom et son numéro d’assurance sociale.
SIN/Numéro d’assurance sociale
Name/Nom (Last name, first name/Nom de famille, prenom)
Please Review Carefully and Sign Below
To: Concentra Trust – Trustee
• I hereby apply for participation in the Canadian Worker Co-operative Federation Self-Directed Retirement Savings Plan in accordance with the Declaration
of Trust supplied to me.
• I request that the Trustee apply for registration of my Plan as a retirement savings plan with the proper authorities pursuant to the
provisions of the Income Tax Act (Canada).
• I hereby acknowledge that:
• I am solely responsible for determining the amount of contribution to the Plan which I may claim as a deduction under applicable tax legislation.
• Any payments received by me under the Plan must be included in my income for the taxation year of receipt and will be subject to tax under the applicable tax legislation.
• It is my responsibility to ensure that all investments purchased for the Plan are qualified as defined in the Income Tax Act (Canada).
• I confirm that the information provided to Concentra Financial Services Association, its agents or affiliates (collectively “Concentra Financial”) is complete and
accurate. I hereby agree and consent to, and accept this as notice of, the terms of the Concentra Financial Confidentiality and Privacy Statement (located at
http://www.concentrafinancial.ca/confidential_privacy.asp). I further agree and consent to Concentra Financial obtaining and retaining my personal information in
order to ascertain my identity as required by the Proceeds of Crime (Money Laundering) and Terrorist Financing Act and as required by law.
Prière de Revoir Attentivement et de Signer Ci-dessous.
Destinataire: La Société de Concentra – Fiduciaire
• Je demande par les présentes à participer au Régime d’épargne-retraite autogéré du Canadian Worker Co-operative Federation conformément à la
Déclaration de fiducie qui m’a été remise.
• Je demande au fiduciaire de faire enregistrer mon régime à titre d’un régime d’épargne retraite auprés des autorités appropriées en application de la Loi de l’impôt sur le revenu (Canada).
• Je connais par les présentes que:
• Je suis le seul à pouvoir déterminer le montant des cotisations à verser au régime, cotisations que je pourrai déduire de mon revenu imposable en vertu des lois fiscales applicables.
• Je devrai inclure dans mon revenu pour l’année d’imposition en cours les sommes qui me seront versées en vertu du régime et que ces sommes seront imposables en vertu des lois fiscales applicables.
• Je suis le seul à pouvoir détérminer les placements sont quàlifiér sur la Loi de l’impôt sur le revenu (Canada).
• Je confirme que les renseignements fournis à l’Association de services financiers Concentra, ses agents ou sociétés affiliées (collectivement, « Services
financiers Concentra ») sont complets et exacts. Par la présente, j’accepte et je consens à ce que ce document serve d’avis quant aux termes de la
déclaration de confidentialité et de protection des renseignements personnels des Services financiers Concentra (qui peut être consultée à l’adresse
suivante : http://www.concentrafinancial.ca/confidential_privacy.asp). J’accepte et je consens également à ce que les Services financiers Concentra
obtiennent et conservent mes renseignements personnels afin qu’ils puissent s’assurer de mon identité, tel que requis par la Loi sur le recyclage des
produits de la criminalité (blanchiment d’argent) et le financement des activités terroristes, et par la loi.
Date
Annuitant’s Signature/Signature du Rentier
Accepted by Canadian Worker Co-operative Federation
as Authorized Agent for the Trustee/Accepté par
Canadian Worker Co-operative Federation agent autorisé
par le fiduciaire
Agent Name/Nom de Agent
500-038 Cdn. Worker Co-op. Fed (RSP Bilingual) (01/09)
© 2008, Concentra Financial
Agent Telephone/Telephone de Agent
Part/Copie 1 - Canadiann Worker Co-operative Federation Part/Copie 2 - Client/Rentier
Designation of Beneficiary
RETIREMENT SAVINGS PLAN
The Canadian Worker Cooperative Federation
la Fédération canadienne des coopératives de travail
Client Contract #. _________________
Annuitant Name: _________________________________________________
Select one: ____ First designation (add)
____ Changing or removing designation (update)
I, _________________________________________________________________, of ___________________________________,
in the Province of ___________________________, the annuitant under the contract referred to above, declare that:
a)
b)
c)
I hereby revoke any prior Designation of Beneficiary made by me under this contract.
The beneficiary(s) designated herein must survive me and accept this designation in order to receive benefits payable under
this contract. If more than one beneficiary is entitled to receive benefits, they shall share the proceeds equally, unless otherwise
specified below. The Alternate Beneficiary designation is valid only in the event that all the Primary Beneficiaries listed herein have
predeceased me or refused the designation. If no beneficiary designated herein survives me or accepts this designation, the
proceeds of this contract shall be paid to my estate.
All sums falling due under this contract, on or after my death, shall be paid to the Beneficiary(s) listed below.
Primary Beneficiary
Name: _________________________________________________ Relationship: _________________________________
Address: _______________________________________________ SIN: _________________________ Minor (Y/N) ____
Name: _________________________________________________ Relationship: _________________________________
Address: _______________________________________________ SIN: _________________________ Minor (Y/N) ____
Name: _________________________________________________ Relationship: _________________________________
Address: _______________________________________________ SIN: _________________________ Minor (Y/N) ____
Alternative Beneficiary(s) – Optional
Valid only in the even that all the primary beneficiaries listed above predeceased me or refuse the above appointment.
Name: _________________________________________________ Relationship: _________________________________
Address: _______________________________________________ SIN: _________________________ Minor (Y/N) ____
Name: _________________________________________________ Relationship: _________________________________
Address: _______________________________________________ SIN: _________________________ Minor (Y/N) ____
CAUTION:
1) Your designation of beneficiary by means of a designation form will not be revoked or changed
automatically by any future marriage or divorce. Should you wish to change your beneficiary in
the event of a future marriage or divorce, you will have to do so by means of a new designation.
2) If funds contained in this contract are subject to a pension legislation, the addendum governing such
funds override this designation if a person other than your “spouse”(or other individual who has been
given similar rights under the applicable pension jurisdiction) is designated to receive the proceeds.
3) Your estate may be responsible for reporting and paying income tax on proceeds paid to a designated
beneficiary.
/
Date (day/month/year)
/
Witness
Annuitant’s Signature
(should not b e a beneficiary or relative of annuitant)
Received by: ____________ Approved by: ____________ Entered By: ____________ Date Stamp:
DOB-CWCF (10/03)
Produce three copies, one for CWCF, one for Annuitant, one for Agent.
SELF-DIRECTED REGISTERED PLAN
FEE SCHEDULE
I, _______________________________________ (hereinafter referred to as
the “Planholder”)
hereby agree to pay to the Canadian Worker Co-operative Federation
(hereinafter referred to as “CWCF”), the following:
Note: Eligible investments in the plan are limited to the Co-op’s offering and cash.
Annual Trustee Fee (including HST)
$50
Transaction Services (Charged at time of occurrence)
N/C
• One Deposit per annum
$50
• Partial withdrawal/transfer in cash (including Refund of
Excess Contribution)
$50
• Unscheduled Statement of Account
$50
• Additional Contribution in Kind or acquisition of securities
per transaction
$75
• Account closing
Other Fees (Charged at time of occurrence)
• All necessary incurred out-of-pocket charges, such as wire services, foreign
currency services and courier charges
• When the Planholder requests detail of events that have been reported by a prior
year’s statement, research fees are based on actual time charges*
• Additional time charges* where CWCF is instructed or obligated, by action of the
Planholder to:
• carry out functions considered beyond the scope or obligation of normal
administrative routine.
*Time charges billed at $50.00 per hour, minimum $50.00
Fees are subject to change upon thirty (30) days notice. A Planholder who
agreement with a new fee schedule may request the plan be transferred to a
If CWCF has not been notified of the request to the transfer the plan to a
within thirty (30) days from receipt of said notification, the amended fee
will take effect from the stated date.
is not in
new trustee.
new trustee
schedule
Annually, CWCF will provide the Co-op, as its agent for the purpose of collecting fees,
with a list, in duplicate, of contracts, together with an invoice for each Planholder,
confirming the annual fee. The Co-op is responsible for delivering the invoices to each
Planholder and for collecting the fees. Said fees are to be remitted to the CWCF,
together with a copy of the above-mentioned list, by the date specified by CWCF.
Termination of the agency relationship between the Co-op and Trustee does not result
in termination of the contract between the Trustee and the Planholder; that contract
will continue in full force and effect under the terms provided in the Declaration of
Trust.
___________________ ____________
Date
Contract #
Company Fee Schedule
____________________________________
Signature or Planholder
PAYMENT AUTHORIZATION FORM
I,_____________________________________ agree to pay,
__________________________________________________, (Co-op),
any and all of the self-directed RRSP administration fees levied
on my account by the Canadian Worker Co-operative Federation. I
authorize the Co-op to deduct from any of my Co-op wages or income
the self-directed RRSP administration fee and pay it on my behalf,
as set out in the Agreement entered into by my Co-op and the
Canadian Worker Co-operative Federation.
I understand that the annual fee is currently $50.00 per year.
the fee changes, I will be notified by my Co-op.
Should I leave the employ of the Co-op and
remitted the fee for that calender year, I
for remitting the fee. Also, I understand
will be charged when the SD RSP account is
___________________________
Date
If
the Co-op has not
will become responsible
that a fee of $75.00
closed.
______________________________
Planholder's signature
Self-Directed Retirement Savings Plan
DEPOSIT FORM
Contract Number / Numéro de contrat
The Canadian Worker Cooperative Federation
la Fédération canadienne des coopératives de travail
Personal Information / Information privée
Do not combine spousal
and non-spousal deposits
into the same contract.
Utilisez un autie contrat pour
les cotisations du conjoint.
Annuitant / Rentier (last name, first name / nom de famille, prénom)
Contributor Information / Information de cotisant
Is this a spousal deposit / transfer?
Y =Yes / Oui
Une contisation par conjoint?
____ N = No / Non
If “Yes,” complete the following:
Dans l’affirmation, completez le suivant:
Contributor’s SIN:
Contributor / Contisant (last name, first name / nom de famille, prénom):
Numéro d’assurance sociale de rentier:
Deposit Detail /
Transaction Code
Cash Contribution, HBP / LLP Repayment, or Transfer from RRIF
____ Somme d’argent, reimbursement d’un RAP / REEP, ou transfert de FERR
Contribution in kind (complete Securities Deposits below)
____ Cotisation en nature (completez le Dépôt des titres en dessous)
Home Buyers’ Plan Cancellation
____ Annulation d’une Régime d’accession à la propriéte REER
Transfer from RRSP, RPP, DPSP
____ Transfert d’une REER, RPA, RPDB
Deposit Date
Date de dépôt
MM / MM DD / JJ YYYY / AAAA
Deposit Amount:
Total de depot:
$ _________________.______
Transfer from a Deceased Spouse’s RRSP / RRIF
____ Transfert d’un REER / FERR d’un conjoint décédé
Transfer from a Retiring Allowance / Severance Pay
____ Transfert d’une allocation de retraite / prime indemnité
Securities Deposits / Dépôt des titres
(Description of Securities)
________________________________________________________ $ ___________________________
________________________________________________________ $ ___________________________
________________________________________________________ $ ___________________________
________________________________________________________ $ ___________________________
Annuitant’s Signature / Signature de rentier
Date
Accepted by Authorized Agent / Accepté par agent agree (signature)
Agent Name / Nom d’agent
Agent Telephone / Téléphone d’agent
DF-CWCF (10/03)
Produce three copies, one for CWCF, one for Client, one for Agent.
WORKER COOPERATIVE AND
SPECIFIED COOPERATIVE CORPORATION SHARES
ANNUITANT DECLARATION
I, ____________________________, the Annuitant of a Canadian Worker Co-operative
Federation Self-Directed RRSP Plan number ______________________, (my “Plan”) confirm
that
I
want
to
purchase
___________________________
________________
(name
of
cooperative)
(number
for
a
of
shares)
purchase
price
of
of
$__________________.
I understand that the total of all classes of shares of this cooperative or any related
cooperative, both inside my registered plans and outside my registered plans PLUS the total of
all classes of shares of this cooperative owned by a person that does not deal at arm’s length
with me, is less than 10% of the issued shares of any class of this cooperative or any related
cooperative.
I hereby confirm that the total of all classes of shares of this cooperative or any related
cooperative, or related cooperative, owned by me (as a beneficial owner inside a registered
plan and/or outside a registered plan) PLUS the total of all classes of shares of this cooperative
owned by a related person is less than 10% of the issued shares of any class of this
cooperative or any related cooperative.
I understand that it is my responsibility to ensure this maximum is not exceeded and that if
this maximum is exceeded, the shares of this cooperative will be deemed a prohibited
investment for my Self-Directed RRSP. As a result, I am liable outside my Self-Directed RRSP
to the CRA for a tax penalty of 50% of the FMV of those shares PLUS a tax penalty of 100% on
any income earned on those cooperative shares.
Dated: ____________________
__________________________________
(Annuitant’s Signature)
305-348 (06/12)
© 2012, Concentra Financial
________________________________
(Witness)
Please return completed form with cheque,
and any applicable attachments, to the
Canadian Worker Co-operative Federation.
Direct Transfer-In
The Canadian Worker Cooperative Federation
la Fédération canadienne des coopératives de travail
Part I: Annuitant Request
_________________________________________________ _____________________ ________________________________
(name)
(social insurance number) (telephone)
__________________________________________________________________________________________________________
(address)
__________________________________________________________________________________________________________
(Transferor Institution name, address and phone number)
__________________________________________________________________________________________________________
_____________________________________________
(Contract or Plan #)
____________________
(Deposit #)
___________________________________
(Maturity Date, if applicable)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
PLEASE TRANSFER:
____ all of the property, OR, ____ lump Net Sum of $ ____________
FROM: ___ RRSP
TO: Contract # ____________
Specimen Plan
___ RRIFC
Canadian Worker Co-op Federation
_X__SD RSP 145-698
___ RPP
PO Box 89, Grand Pre, NS
___ DPSP
B0P 1MO
___ Retiring Allowance
If from RPP/DPSP: ____ I am the member, OR, ____ the beneficiary spouse, OR, ____ former spouse due to marriage breakdown
___________________________________________________________________________________________________________
Date: ________________________ Annuitant Signature: __________________________________ OR, ____ see attached letter
Certified by: _____________________________________________________________, Canadian Worker Co-operative Federation
(Authorized Agent name and phone number)
(Transferee Institution)
Part II: Transfer Institution
Amount transferred: $ _______________ (Transferor to issue T4RIF for transfers from RRIF to RRSP, or T4A for Retiring Allowance transfer.)
Spousal contributions: ___No ___Yes…contributor name: ________________________________ SIN: _____________________
Locked in Funds:
The CWCF SD RSP does not accept Locked in Funds
(Date)
DTI-CWCF (10/03)
(Authorized Signature of Transferor Institution)
(Contact phone number)
Produce two copies, one for Annuitant, one to Transferor Institution