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Please advise us if you wish to have further information about any of the following: – accruing service for any period after August 1992, during which you received Extended Disability Benefit Insurance YES NO – purchasing a period of disability that occurred prior to September 1992 YES NO – purchasing substitute teaching service that was provided in Alberta since May 1971 YES NO – purchasing a leave of absence that was granted by your employer YES NO – purchasing previously refunded service YES NO – transferring service from another pension plan in Canada (party to a reciprocal agreement with ATRF) YES NO Applicant’s Signature This certifies that I have read the information on the reverse of this form and clearly understand the choice I have made..
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