Name of the plan: ___________________________
I, _______________________, being duly authorized to act as administrator or mandatary of the administrator of the plan mentioned above, declare that the plan is being terminated and that the date of its termination is______________________.
I certify that:
(1) the termination follows a decision made by the person or body empowered to terminate the plan in accordance with the plan provisions;
(2) the decision to terminate the plan was communicated by means of a written notice, a copy of which is attached hereto, that, to the best of my knowledge, was sent to all the affected members and beneficiaries (that is, all the plan’s members and beneficiaries whose benefits were not paid in full before the termination date and, if the termination resulted from a division, merger, disposal or closure of the enterprise or a part of the enterprise, all the members whose active membership ceased during the period between the date on which the members were informed of the event in question and the termination date), the accredited association representing the members, the pension committee and the insurer, if any;
(3) the notice referred to in paragraph 2 indicates the plan’s termination date;
(4) the termination date mentioned above is not subsequent to the day preceding the day on which the benefits of the plan’s last member or beneficiary were paid;
(5) to the best of my knowledge, the termination date (check, as appropriate, one of the following boxes):
⃞ is not prior to the date of the cessation of collection of member contributions nor the date preceding by 30 days the transmittal of the notice of termination to the active members;
⃞ is prior to the date of the cessation of collection of member contributions or the date preceding by 30 days the transmittal of the notice of termination to the active members, but each of the members whose active membership ended on the occasion of the termination or thereafter has consented in writing to the termination of the plan at the date mentioned above and the pension committee is able to produce those consents at the request of Retraite Québec;
(6) the pension committee received the written notice of termination on ________________.
Attachment: notice of termination.