NORTHERN EMPLOYEE BENEFITS SERVICES (NEBS)
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#700 – 5201 50
Avenue, Northwest Tower, Yellowknife, NT X1A 3S9
EMPLOYEE DISCONTINUANCE FORM
COMPLETE AND MAIL ORIGINAL TO NEBS OFFICE (ADDRESS ABOVE)
TO BE COMPLETED BY EMPLOYER MEMBER
Name of Employer:
Name of Employee
Social Insurance Number:
Effective Date of Discontinuance:
Reason for Discontinuance:
Date
Employer Signature
TO BE COMPLETED BY EMPLOYEE
If you are being employed by another Member of NEBS, your NEBS coverage and Pension may be continuous.
New Employer
Start Date
TO BE COMPLETED BY PENSION MEMBERS
As a member of the NEBS Pension Plan you have options for the contributions you have made.
A.
IF YOU HAVE BEEN A CONTRIBUTING MEMBER OF THE PENSION PLAN FOR LESS THAN TWO YEARS, YOU CAN ELECT
THE FOLLOWING (PLEASE CHECK ONE):
Cash Refund
Transfer to RRSP
Transfer to Other Pension Plan
If you choose one of the transfer options, a completed Revenue Canada T2151(E) form is required.
Date
Member Signature
Mailing Address and Phone Number of Member
B.
IF YOU HAVE BEEN A CONTRIBUTING MEMBER OF THE PENSION PLAN FOR MORE THAN TWO YEARS, NEBS WILL SEND
YOU YOUR BENEFIT OPTIONS. PLEASE COMPLETE THE INFORMATION REQUIRED BELOW.
Date
Member Signature
Mailing Address and Phone Number of Member
YOU WILL RECEIVE YOUR NEBS TERMINATION PACKAGE WITHIN 60 DAYS OF YOUR TERMINATION