Step 2: Tell us how you want your account balance invested.

Money MarketBond

Invest My Account Balance

Asset Allocation Fund %

Bond

Money Market

%

%

Total 100%

monthly payments of $ beginning .

annual payments of $ beginning .(month/year)(before taxes)

(month/year)(before taxes)

SECTION B: SET UP YOUR INVESTMENT FUND INSTRUCTIONS

1000 - 1801 Hamilton StreetREGINA, SK S4P 4W3Phone: 306-787-5442

Fax: 306-787-0244 Toll free: 1-877-275-7377

Email: pepp@peba.gov.sk.ca

Application for Variable Pension Benefit (VPB)

PEPP Member Number (current PEPP member only)

Last Name, First Name and Initial Termination Date (day/month/year)

Mailing Address City Province Postal Code

SECTION A: MEMBER INFORMATION (Please print)

Birthdate (day/month/year) Phone NumbersHomeBusiness

Email AddressSocial Insurance Number

July 2019

SECTION C: INDICATE THE AGE TO BE USED FOR THE MINIMUM PAYMENT

Please use my age or my spouse’s age for the required minimum annual withdrawal calculation.

You must complete Sections A through F and ensure all applicable documents are included. A list of the documents can be found in the attached guide. PLEASE SEND IN ORIGINAL FORM.

Step 1: Choose your fund(s).Asset Allocation Funds (You may select ONE from this group): PEPP Steps (Default Fund) Accelerated Growth Growth Balanced Moderate

Conservative

I am a current PEPP member - I am transferring my entire PEPP account balance.I understand that until I notify PEPP which fund I choose, my contributions will be invested according to my existing instructions. (If you would like to change your existing instructions, complete Section B)

I am a former member returning to PEPP - I am transferring in $ . I understand that until I notify PEPP which fund I choose, my money will be invested in the default fund, the PEPP Steps Fund.

SECTION D: SELECT YOUR PAYMENT OPTIONS AND PAYMENT INSTRUCTIONS

Scheduled Payment1 Options:

Additional Payment Options:

I would like to receive an immediate (requires 4 days) single lump-sum payment of $ .

I do not want a payment at this time*.

(before taxes)

* Minimum payments are required beginning at age 72. If you do not withdraw the minimum required it will be paid to your bank account atcalendar year end.

Specialty Funds (You may select up to TWO from this group):

and/or

1 Scheduled payments are made on the last banking day of the month.

SECTION E: RELATIONSHIP STATUS AND BENEFICIARY DESIGNATION

Beneficiary 1 - Full Name Relationship Portion (out of 100%)Birthdate (day/month/year)

Beneficiary 2 - Full Name Relationship Portion (out of 100%)Birthdate (day/month/year)

Beneficiary 3 - Full Name Relationship Portion (out of 100%)Birthdate (day/month/year)

Other Beneficiaries (Please attach the address(es); or address the same as member)

Spouse as Beneficiary See page four for further explanation

SECTION F: DECLARATION OF UNDERSTANDING

Signature of Member (electronic signature will not be accepted) Date (day/month/year)

Payment Instructions

I have one investment fund. PEPP will make payments from that fund until it is depleted ($0.00).

I have multiple investment funds.

Please pro-rate the payments based on the ORbalance in each of my funds.

Please make my payments by depleting my funds in this order

1.

2.

3.

Relationship Status: No Spouse (includes single, divorced, widowed) Spouse (includes legally married, separated, common-law)

If you have a spouse (married, or common-law) your spouse must complete the Spouse’s Consent and Waiver of Post‑Retirement Survivor Benefits.

*Portion is always 100% for a spouse as a specified beneficiary..

SECTION G: TO BE COMPLETED BY PEPP ADMINISTRATION

Entered onto system by onDate (day/month/year)

Spouse’s Full Name Relationship Portion (out of 100%)Birthdate (day/month/year)

Specified

OtherSpouse

By signing below I acknowledge that:• I have read and understand the options and choices I have made on this application;• I understand that the VPB allows me to withdraw the money, subject to the minimum annual withdrawal payment

required by the Income Tax Act, (Canada);• I understand that there is no maximum withdrawal restriction. I may withdraw part or all of the balance of the VPB

account at any time.• I am responsible for my investment decisions and understand that investing involves risk and that it is my

responsibility to seek the appropriate financial counseling in making my investment decisions;• I understand that if I have an account balance with PEPP, my current account balance will be transferred to reflect

my investment instructions in Section B (only if applicable);• I understand that my existing investment option will continue until I provide alternate instructions;• I understand that if the investment decisions I make do not meet expectations, neither PEPP, nor the Government of

Saskatchewan, nor any of their employees or agents, has any liability to me, arising from my investment decisions oracting in accordance with my instructions, including any default instructions;

• I hereby revoke any prior beneficiary designations and name the individuals in Section E to receive any amountpayable from PEPP in the event of my death; and

• The information provided on this form is accurate and correct as of the date of my signature.

100%*

PrimaryAlternate

PrimaryAlternatePrimaryAlternate

COMMENTS AND INSTRUCTIONS

This guide is intended to help members complete their Application for Variable Pension Benefit (VPB) form. If you require more information, please visit our website at www.peba.gov.sk.ca or contact PEPP.

SECTION A - MEMBER INFORMATION

Please provide PEPP with some basic information about yourself. Current and former PEPP members can apply for the VPB, so please indicate which applies to you. You must have a minimum account balance to qualify for the VPB.

SECTION B - INVESTMENT INSTRUCTIONSSelect a fund: Choose from six asset allocation funds (PEPP Steps, Conservative, Moderate, Balanced, Growth or Accelerated Growth) and two specialty funds (Bond or Money Market). You may invest in up to three funds at one time. Also,you may invest in one asset allocation fund at a time, and add one or both of the specialty funds or invest solely in specialty funds.

Investment Instructions: You may decide to put 100% of your account into one fund from the Asset Allocation Funds and/or the Bond and Money Market Fund; or you may split (different percentages) your account between one fund from the Asset Allocation and/or the Bond and Money Market Fund. You may transfer among the funds at any time providing you never hold more than one fund from the Asset Allocation Funds. The first two inter-fund transfers in a fiscal year (April 1 - March 31) are free of charge. A $30.00 processing fee is charged for the third and each subsequent inter-fund transfer using an Investment Option Change form. All transfers completed using PEPP Access are free of charge.

More information on PEPP investment options is available on our website.

SECTION C - AGE FOR MINIMUM PAYMENTRequired minimum withdrawals (based on Income Tax Regulations) must begin the calendar year the member reaches age 72. The calculation involves your total account balance multiplied by a prescribed factor that increases with age. Please indicate whether you wish to use your age or your spouse’s age for use in this calculation.

SECTION D - PAYMENT OPTIONS AND PAYMENT INSTRUCTIONSYou can schedule payments, request lump-sum payments, or do both, or not take any payments if you are less than age 72.

• Prior to age 72 there is no minimum withdrawal required. • The maximum you can withdraw is your total account balance at any time.• All withdrawals from your VPB account are paid electronically directly to your bank account. • VPB payments cease and the account is closed once the balance is depleted to $0.00.

Payments are made by redeeming units from your account based on your payment instructions.

You may change the fund from which payments are made once each fiscal year at no charge. A $25.00 fee applies for each additional change within the fiscal year.

Income Tax

Your VPB account is tax-sheltered and tax-deferred until withdrawals/payments are made. PEPP is required to withhold income tax from all payments and forward it to the Canada Revenue Agency (CRA) on your behalf. You will receive a T4A slip each year.

VPB members are eligible at age 65 for a $2,000 pension income amount used for determining non-refundable tax credits and income splitting with their spouse when filing their annual tax return.

Ultimately, the tax liability falls to you and will be determined when filing your personal income tax return. Please forward a completed TD1 (CRA and provincial) to PEPP.

SECTION E - RELATIONSHIP STATUS AND BENEFICIARY DESIGNATION

Please indicate your relationship status and name your beneficiary or beneficiaries. The most current definition of spouse and more information on this topic can be found in the PEPP Talk on Designation of Beneficiary. If you have a spouse, your spouse must complete a Spouse’s Consent and Waiver of Post‑Retirement Survivor Benefits.

SPOUSE AS BENEFICIARY:If you have a spouse, that person is your beneficiary of 100 per cent of the death benefit. You must name your spouse as specified or other beneficiary. If you wish your spouse to receive 100 per cent of the benefit and be able to remain in the VPB uninterrupted after your death, name your spouse as a specified beneficiary. Your spouse then has several options and the time to choose how to handle the account, or to just continue receiving payments from it until it is depleted. Only the spouse of the member can be a specified beneficiary. Specified beneficiary receives 100 per cent of the death benefit – no sharing.

Choose other if your spouse will not be continuing the VPB account after your death or if your spouse is sharing the death benefit (has waived rights to all or a portion of benefit). This will allow you to designate all or a portion of the benefit to a beneficiary(ies) other than your spouse. If your spouse waives rights to all of the benefit show zero as the portion. To waive these benefits your spouse must complete a Spouse’s Waiver of Designated Beneficiary Status form from our website and submit it to PEPP. Please see the PEPP Talk on VPB for more information on beneficiary(ies).

OTHER BENEFICIARY(IES):Any beneficiary who is not your spouse (children, your estate, or any other person or organization) is an other beneficiary.

Primary vs Alternate: Primary beneficiary(ies) is the person you are naming to receive the benefit. The alternate would receive the benefit if the primary is unable – perhaps has pre-deceased you. Other beneficiaries will receive a payout (less tax) as soon as practical after the member’s death.

If you have no beneficiary designated and no spouse, the account balance will go to your estate.

DOCUMENTS AND CERTIFICATES REQUIRED FOR PROCESSING THE APPLICATION

CERTIFICATES: Your birth certificate Your spouse’s birth certificate (if applicable) Your marriage certificate, if you are married Proof of death if your spouse is deceased or the divorce certificate or Decree

Absolute or if you are not now in a spousal relationship but were previously - we require proof of your “single” status

FORMS: Spouse’s Consent and Waiver of Post‑Retirement Survivor Benefits required if you have a spouse Spouse’s Waiver of Designated Beneficiary Status (if applicable) Declaration of Common‑law Relationship form (available at www.peba.gov.sk.ca) if you are not married but have a

common-law spouse Proof of membership for former PEPP members. This can be a previous PEPP member statement, a T4 or a payslip

showing PEPP deductions

BANKING AND TAX FORMS: A completed PEPP Banking Information form A blank void cheque or direct deposit form showing your banking information A completed TD1 form (CRA and provincial) Applicable Canada Revenue Agency transfer documents for members transferring money into the VPB from

outside sources (T2033 for RRSPs, T2151 for locked-in transfers)

Your VPB account cannot be activated until all documentation is received.

All certificates must be a certified copy of the original. Please check the PEBA website under Acceptable Documentation for a list of individuals who can certify your documents.