IUPAT Logo Canadian Flag
INTERNATIONAL UNION OF PAINTERS AND ALLIED TRADES
INDUSTRY PENSION PLAN
Fiddlers Green Postal Outlet - P.O. Box 81032
Ancaster, Ontario L9G 4X1
Phone (800) 554-2479 / Fax (866) 656-4160 - Email: [email protected]

Section A:  Applicant Information (The person to be paid - Complete All Fields)
Enter Street Address
Enter Date of Birth
Enter City
Select Province
Postal Code
SIN without hyphens
Home Phone Number
Cell Phone Number
Email Address
Enter the desired Month and
Year for start of Retirement Pay
(Date must be within 6 months):
Month
Year
Mother's Maiden Name
Relationship to the Participant with Pension Plan Benefits (Select One):
Section B:  Participant Information (The Person who worked and has Pension Plan Benefits)
SIN without hyphens
Enter Date of Birth
Last District Council or Local Union
Marital Status
Home Phone Number
Cell Phone Number
Current or last IUPAT Plan / Company worked (or intended last date)
Date Last Worked
Employer
Select Province
Section C:  Canada (Quebec) Pension Plan Disability
If you are applying for retirement based on disability, please complete this section.
If your pension Plan Disability application has been approved, submit Canada (Quebec) Pension Plan Disability Benefit Award attached to this application. This document must be received before benefit can be paid.

Section D:  Spousal Information

If you have a spouse, please complete the following section and this information will be included on a Declaration of Spousal Status form for your signature. Click button above for Spousal Definitions by Province.
Address of Spouse (If different from applicant)
Street Address
City
Select Province
Postal Code
Date of Birth
SIN without hyphens
Spouses Marital Status
Date of Separation or Common Law Relationship
Section E:  Beneficiary Information
Complete this section if you do not have a spouse or if your spouse has waived his/her entitlement to a joint and Survivor Benefit. Please note that by signing Section G of this application, you revoke any previous beneficiary designations and designate the following beneficiary to receive any remaining guaranteed pension payments upon your death.
Address of Spouse (If different from applicant)
Street Address
City
Select Province
Postal Code
Date of Birth
SIN without hyphens
Relationship to Plan participant
Section F:  Declaration of Spousal Status
Complete this section in the presence of a witness. Check the statement that applies to you. You must check at least one of the boxes below:

Applicant Signature __________________________________________________________
Date ___________________________
Non-Relative Witness Signature _____________________________________________
Date ___________________________
Section G:  Applicant's Statement
I hereby apply for a pension from the International Painters and Allied Trades Industry Pension Fund (Canada). The statements contained in this application are true to the best of my knowledge and belief. I understand that a false statement may disqualify me for pension benefits and that the Trustees shall have the right to recover any payments made to me because of a false statement.

Applicant Signature __________________________________________________________
Date ___________________________
Non-Relative Witness Signature _____________________________________________
Date ___________________________
OPTIONAL: Receive Text/SMS Pension Application Status Messages
To receive text/sms status updates on your Pension Application, provide your cell/mobile number below. (Cellular messaging rates may apply)
Mobile/Cell Phone Number for SMS messages

Please review and submit your application (only submit one application, multiple submissions will delay processing). Once submitted a printable version of your application will be generated that you will need to sign and if required have notarized (see section 7); a second page will be generated that will provide instructions for mailing this signed hard-copy form to the IUPAT Pension Fund along with copies of any required supporting documents (this will be listed for you as a checklist). If you have questions or need assistance, contact the IUPAT Pension Fund at (800)544-2479.