Certificate Of Compliance
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1
2DLP 2/ FORM A
CERTIFICATE OF COMPLIANCE – PENSIONS ENROLLMENT FORM
NOTE: CERTIFICATE VALID FOR 6 MONTHS FROM DATE OF PPA OFFICIAL STAMP.
PLEASE REFER TO THE GUIDANCE NOTES ON THE BACK OF THIS FORM.
SECTION A: TO BE COMPLETED BY EMPLOYER
1.
Employer / Business Name: _________________________________________________________________________________
2.
Contact Person: ________________________________________
Tel#: __________________________________________
3.
Mobile #: _________________________________
Email: ______________________________________________________
4.
Please provide the Name(s) of your Pension Plan(s) registered pursuant to Sections 4 and 25 of the National Pensions Law.
[Note: Please refer to Employer Guidance Note (A)]
_______________________________________________________________________________________________________
5.
What is your Employer Pension Registration Number(s) for each pension plan? ________________________________________
_______________________________________________________________________________________________________
[Note: Please refer to Employer Guidance Note (A)]
6.
Are all pension contributions for all enrolled employees paid up-to-date? Yes
No
If no, why not? ___________________________________________________________________________________________
7.
Below
or
attached
is
a
list
of
employees
of
[INSERT
NAME
OF
EMPLOYER]
_________________________________________________, including their names, dates of birth, nationalities, dates of
commencement of employment, Immigration status, as well as the name(s) of the pension plan(s).
8.
[INSERT EMPLOYEE LIST HERE OR ATTACH EMPLOYEE LIST TO THIS FORM (DLP 2 / FORM A)]
Employee Name
Date of Birth
Nationality
Immigration Status
Employment
Name of
(Caymanian, Permit
Start Date
Pension Plan
Holder etc.)
Employer Declaration:
I / We, ____________________________________, [INSERT EMPLOYER NAME HERE ]
certify that the above stated information provided is
,
true and correct and confirm that I am / we are compliant with the National Pensions Law & Regulations. I / We declare that the above
stated information provided is correct and to the best of my / our knowledge and belief. I am / We are aware that it is a criminal offence to
make a statement or representation that is false in a material fact which I / we know to be false or do not believe to be true. I / We also
confirm that upon signing this form, we have read and understood this declaration.
[Note: Please refer to the Guidance Notes for the
Employer in its entirety.]
__________________________________
__________________________
________________________
Print Name of Employer
Authorised Signature
Date
dd/mm/yyyy
Please refer to Employer Guidance Note (B)
Official Date
SECTION B: TO BE COMPLETED BY PENSION PLAN
Stamp of
Approved
1.
When was the last pension contribution period paid?
__________________________________
Pension Plan
Date
dd/mm/yyyy
2.
To our knowledge, all pension contributions for all enrolled employees are paid up-to-date. Yes
No
Pension Plan Declaration:
We, _____________________________________________, [ INSERT NAME OF PPA HERE ], certify that the above stated information
provided in Section A is in agreement with our Company’s records, as at the time of this document being completed and signed by us. We
also confirm that upon signing this form, we have read and understood this declaration.
[Note: Please refer to the Guidance Notes for the
Pension Plans in its entirety.]
__________________________________
__________________________
________________________
Print Name of Pension Plan
Authorised Signature
Date
dd/mm/yyyy
Please refer to Pension Plan Guidance Note (B)
Please turn over to the next page
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Parent category: Business