OMERS Pension Guide

DECLARATION - (Please read the following statements before you sign and date the form) I confirm that:

➢ I will join the Plan on the first day of my first full month’s employment.

➢ I understand that if I don’t return this form to JMA (corporate@jmurray.co.uk) by the payroll cut-off

date in my first full month of employment, my default contribution will 5% of basic salary.

➢ I have received the welcome email provided by JMA, which provides detailed information about the

Plan.

➢ I authorise my Employer and JMA to include me in the OMERS Workplace Pension Plan, to deduct my

contributions from salary as instructed by me, to invest those contributions in the default funds (unless

specified otherwise) and to provide Aviva with my personal information, necessary to administer the

plan.

➢ I agree to be bound by the rules of the OMERS Workplace Pension Plan. I understand that I will be sent

a Policy Document and a Cancellation Notice (only to be used if you no longer want to be a part of the

Scheme).

➢ I agree that, to administer my plan, AVIVA can (i) act upon reasonable instructions on my behalf from

my employer or any adviser appointed by my employer and (ii) disclose any necessary information to

any adviser appointed by my employer.

➢ I accept responsibility for any losses or expenses resulting from any untrue, misleading, or inaccurate

information deliberately or carelessly provided by myself, or on my behalf, in this form or with respect

to benefits from my plan.

➢ I confirm my ability to afford these contributions both presently and in the future.

Signature:

Print Name:

Date: