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Registered Retirement Savings Plan (RRSP) Application

Please note that this form is for new applications only. You will be required to visit a branch for a signature.
Annuitant
Contributor
Employer Authorization
Select to grant authorization.
Designation of Beneficiary
(Note: Contract number will be added by trustee when the new application is processed.)
  1. I hereby revoke any prior Designation of Beneficiary made by me under this contract.
  2. 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.
  3. All sums falling due under this contract, on or after my death, be paid to the Beneficiary(s) listed below.
  4. I understand this designation will not be recognized where I reside in Quebec at the time of my death.

PRIMARY BENEFICIARY

Primary Beneficiary 1

ALTERNATE BENEFICIARY (S)


Alternate Beneficiary 1
  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 pension legislation, the addendum governing such funds may 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.
  4. Designations are created and governed under provincial legislation, The provincial legislation may override this designation.
Caution
Please Review Carefully

Please Review Carefully and Click Accept Below

To: Concentra Trust - Trustee

  • I hereby apply for participation in the Trustee's Retirement Savings Plan (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 request that this contribution, and any subsequent contributions, be deposited or invested In the Credit Union above named by the Trustee and I acknowledge that the terms and conditions of such deposits or investments have been and will be agreed upon between myself and the Credit Union and that such deposits or investments will be held in trust by the Trustee.

  • 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.

  • I hereby acknowledge that 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.

  • 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 https://www.concentrafinancial.ca/pages/ConfidentialityPrivacy.aspx ). 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 Actand as required by law.

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