1: To Be Completed by the Member
the box of the pension fund to which the member will be transferring.
to Be Provided by the Member:
- Member's full name
- Membership number from previous
- Complete mailing address
- The name of the pension fund in
which they are currently enrolled
- The status of the member leaving
the previous job; i.e. resigned, dismissed and the name of the
- The date of termination
- The name of the new employer
- Member's signature and date
Member must sign and date the form, giving the Division the right
to transfer their contributions from the one fund to the other.
2: To Be Completed by the Former Employer
form must be forwarded to the member's former employer, who must
complete Part 2.
Certifying Officer indicates:
- The status of the member when
they left their location;
- The date of the last pension deduction
taken from the member's salary, and;
- The member's base salary at the
time of termination.
On the lower portion of the form
the employer must indicate the deductions that came in for the member
for the last two quarters. This would include any loan payments
Officer or Board Secretary of the former employer must sign the form and return it to the
new employer immediately. This is imperative.