| FORM A |
| Revenue Account for the period ............................................. To .................................................. |
| Pension Fund Plan |
| Revenue | $ | Expenditure | $ |
| 1. | Amount of the Fund at the beginning of the period. | | 1. | Superannuation Benefits— |
| (a) pension to retired employees |
| | (b) widows' pensions |
| 2. | Contributions by employees. | | | (c) orphans' pensions |
| (d) retirement gratuities. |
| 3. | Contributions by employers. | | 2. | Death grants. |
| 4. | Any additional contribution by employer to meet deficiency or back service liabilities. | | 3. | Return of contribution on withdrawal. |
| 4. | Other expenditure (to be specified). |
| 5. | Interest dividend and rents. | | 5. | Amount of the Fund at the end of the period.* |
| 6. | Other income (to be specified). | |
| FORM B |
| (Not to be completed for an insured pension fund plan) |
| Balance Sheet as at .............................................................. 20 .............. for ............................................................................... Pension Fund Plan |
| Liabilities | $ | Assets | $ |
| Amount of fund as at | | Government Bonds and Debentures* |
| Pensions due but not yet paid | | Other Bonds and Debentures* |
| Other benefits (to be specified) due but not yet paid | | Ordinary and Preference shares* |
| Mortgages* |
| | Real Estate |
| | Deposit Certificates |
| | Other Assets (specify) |
| * Details to be specified in a Schedule. |