03018E (2018-03) Page 1 of 2

PARTICIPATION IN THE DESJARDINS GROUP PENSION PLAN (DGPP)

REGISTRATION NO.: 25717

year / month / day

Employee's last name First name Social insurance number

Date of birth Sex Language

Previous employers in the Desjardins Group Effective date of employment Date of departure Did you participate in the Desjardins Group Pension Plan?

Yes No

Yes No

year / month / day year / month / day

year / month / day year / month / day

Male Female English French

A - IDENTIFICATION

B - PARTICIPATION IN THE DESJARDINS GROUP PENSION PLAN

Participation in the Desjardins Group Pension Plan is compulsory for employees aged 25 and over and under age 65 who meet the eligibility requirements. However, even if you are an employee who meets the eligibility requirements, your participation is optional if you are aged under 25 or 65 and over. If one of these situations applies, please indicate your choice for your optional participation in the Plan:

I wish to join the Plan. I do not wish to join the Plan.

Signature of employee: Date:

The Québec Supplemental Pension Plans Act provides that at the time of death, the participant’s spouse is always given priority consideration over any other beneficiary. See the definition of spouse on the reverse side of the form.

I DESIGNATE AS BENEFICIARY: RIGHTFUL CLAIMANTS OR

Last and first names Relationship to participant Date of birth % Please check:

REVOCABLE IRREVOCABLE

REVOCABLE IRREVOCABLE

REVOCABLE IRREVOCABLE

year / month / day

year / month / day

year / month / day

C - BENEFICIARY

year / month / day

year / month / dayDate of latest change:

9- Full name of employer

1- Status of employee Regular full-time Casual Regular part-time Temporary

2- Effective date of employment

year / month / day

3- Effective date of employment as a regular employee, if other than 2-

4- Annual salary or Hourly wage

year / month / day year / month / day

6- Date of first day of work at this salary 7- Backdate of pay raise, if applicable

5- Hours worked during a normal week:

Transit number

8- Number of hours normally worked HOURS each week by the employees who do the same type of work:

D - TO BE COMPLETED BY THE EMPLOYER

E - DECLARATION AND AUTHORIZATION FOR THE COLLECTION AND COMMUNICATION OF PERSONAL INFORMATION

I declare that the information provided herein is accurate, complete and true. I acknowledge having read the notice regarding the Personal Information Management section on the reverse side of this form and that I have received a copy thereof.

By signing below, you consent and agree that we collect, verify and share your personal information in order to administer the Plan and pay benefits. The people we may share information with are the employer, your legal representative, your estate (including the liquidator), your beneficiary, your spouse and the financial institutions you do business with. You authorize these individuals to give us any personal information we may require. You authorize your employer to deduct the required contributions from your salary. A photocopy of the current authorization has the same value as the original.

Furthermore, your personal information may be used for the purpose of conducting statistical studies and customer satisfaction study. If you do not authorize us to use your personal information as described previously or if you wish to make any changes to your consent regarding your personal information, please contact the DGPP Member Services Team at the number indicated on the back side. You authorize us to use your Social Insurance Number (SIN) only for income tax and administrative purposes.

Signature of employee: Date: year / month / day

ORIGINAL TO EMPLOYER - COPY TO PARTICIPANT

Signature of employer'sPlan representative: Date: year / month / day

year / month / day

SPOUSE (Desjardins Group Pension Plan’s definition)

(a) The word spouse refers to the person who is married to or living in civil union with the member who is not separated from bed and board from him or her.

(b) If the member is not married or living in a civil union, the spouse is the person who has been living with him or her in a marital relationship for at least three years or, in the following cases, for at least 1 year:(i) if they have or are expecting at least one child of their own;(ii) if they adopted together at least one child during their marital relationship;(iii) if one of them adopted at least one of the other’s children during this relationship;

iv) the birth or adoption of a child during marriage, civil union or a period of marital relationship prior to the marital relationship current on the day when the status of spouse is established, may make it possible to qualify a person as a spouse.

(c) If no one meets any of the above definitions, the spouse is the designated person of whom the Retirement Committee has been informed in writing by the member and who has been living in a marital relationship with the member for at least 1 year.

(d) If no one meets any of the above definitions, the member is considered not to have a spouse for the purposes of the Plan.

(e) In the case of members who die before they retire, the spouse is determinated in keeping with the member’s statute on the day prior to their death. In the case of members who die after their retirement, the spouse is determinated in keeping with the member’s statute on the date pension payments begin.

This spouse is no longer considered the spouse as of such time, after retirement, as the member and the spouse become separated from bed and board or divorced, their marriage or civil union is annulled or they stop living together in a marital relationship, unless there is no transfer of benefits between the spouses at that time and the member advises the Retirement Committee in writing that this person is to remain their spouse.

Revocable: Means that the beneficiary can be changed without the beneficiary’s consent.

Irrevocable: Means that the irrevocable beneficiary’s signature is mandatory to change the beneficiary. The IRREVOCABLE designation of a minor cannot be changed until he or she reaches the majority.

BENEFICIARY

PERSONAL INFORMATION MANAGEMENT

Your personal information is handled in a confidential manner. We keep your information on file exclusively for the administration needs of the Desjardins Group Pension Plan. Your information is consulted only by those of our employees who need to do so in the course of their work.

To find out more about the Policy governing the management and protection of personal information, contact our Privacy Officer at the address mentioned below or visit our website at www.rcd-dgp.com, at the bottom of the homepage, in Privacy Policy.

Privacy OfficerDesjardins Insurance100, rue des CommandeursLévis (Québec) G6V 7N5

You have the right to review your personal information in our files and correct anything that is incomplete, ambiguous or not relevant by contacting your employer's Human Resources department.

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MEMBERSHIP (Desjardins Group Pension Plan’s main eligibility criteria)

(a) All regular full-time employees age 25 or over must be members of the Plan.

(b) All regular part-time employees age 25 or over who work at least 14 hours a week in keeping with the regular work schedule must be members of the Plan.

(c) All other employees age 25 or over must be members of the Plan if they meet either of the following requirements: (i) they received remuneration from their employer amounting to at least 35% of the year’s maximum pensionable earnings (MPE) during the previous calendar year; (ii) they worked at least 700 hours for their employer during the previous calendar year.

(d) Any employee less than 25 who meets the aforementioned requirements in (a), (b) or (c), except with regard to age, may become a member of the Plan on request.

(e) Notwithstanding the requirements in (a), (b) and (c), membership in the Plan for an employee hired on or after normal retirement age (age 65) is optional.

INFORMATION REGARDING THE DGPP

If you have any questions regarding the DGPP, you can contact the DGPP Member Services Team at 1-866-434-3166.