As the Plan Administrator, I certify that the information I have provided in the Plan Administrator's Statement (PAS), and any further verbal or written statement provided by me in the future concerning this claim, is true and complete to the best of my knowledge. I understand that the information in the PAS will be kept in a benefits file relating to this claim and might be accessible by third parties to whom authorized access has been granted. I acknowledge and agree that by submitting this PAS, I consent to the unedited disclosure of any information contained herein to the Trustees of the Ontario Teachers Insurance Plan and OTIP/RAEO Benefits Incorporated (“OTIP”).<br/><br/>I further understand and agree that the typed version of my name in the signature section shall be binding on all parties, including myself, as if that typed name was my original handwritten signature.