Branch Information


Branch Name: Member Number: *

Annuitant Information


First Name: *
Middle Name:
Last Name: *
Birthdate (dd/mm/yyyy): *
Social Insurance Number: *

No Spaces
Address: *
City: *
Province: Postal Code: *

No Spaces eg: e3e3e3
Are you a resident of Canada? * Pension Lock-in? *
Jurisdiction:

Contact Information


Home Phone: *
Cell Phone:
Office Phone:
Fax:
eg: 902 555 1234
Email: *
Confirm Email: *

Contributor


Complete only if this deposit is being made by and claimed as a deduction by your spouse/common-law partner.
Spouse Name:
Spouse SIN:

Investment Details


Your personal account number to debit: *
Indicate your account type and member number to be debited

Select an Investment Option:*
Fixed Rate RSP Minimum Investment
$500.00
$500.00
$500.00
$500.00
$500.00
$500.00 Ltd. Time Offer
$500.00 Ltd. Time Offer
$50.00
*the rates are subject to change without notice.
Amount of Contribution:*

Please Review Carefully Before Submitting


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 understand and acknowledge that the personal information contained herein is being collected by Concentra Trust (the "Trustee") and that by signing below, I confirm that I have read and consent to the terms of the "Concentra" Privacy Policy located on the Concentra website at concentra.ca or by contacting the Trustee at 1-800-788-6311. "Concentra" refers to Concentra Bank and its wholly-owned subsidiary Concentra Trust. I confirm that the information provided herein is true and accurate and I agree to make the above named Credit Union, on behalf of the Trustee, aware of any changes to the personal information contained on this application form.

Do you accept?: *