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HealthPlus

THE CAPCORP PLANNING (2003) INC.
MULTI-EMPLOYER HEALTH AND WELFARE PLAN

PARTICIPATION AGREEMENT

WHEREAS, , hereafter referred to as the "Participating Employee", desires to participate in HealthPlus, the CAPCORP Planning (2003) Inc. Multi-Employer Health and Welfare Plan ("Plan"), and

WHEREAS, hereafter referred to as the "Participating Employer", also agrees to participate in the Plan.
ACCORDINGLY, the undersigned agree that:

1. The Participating Employee shall be entitled to benefits according to the schedule below.
Benefit Type Yes No   Percentage reimbursement
DENTAL CARE BENEFITS   50% 75% 100%
EXTENDED HEALTH CARE BENEFITS   50% 75% 100%
VISION CARE BENEFITS   50% 75% 100%
2. The Participating Employee acknowledges that if he or she submits any claims related to medical conditions that were pre-existing at the time of enrollment in the Plan, the Participating Employer can elect not to fund such claims.
3. Eligible claimants in the Participant's household are (attach second page if necessary):
Name Relationship to Participant
4. The Participating Employer shall make the contributions to the Plan that are required from time to time by the Trustee.
5. The Administrator shall be entitled to rely exclusively on the accuracy of any invoice submitted by a Participating Employer.
6. All contributions made pursuant to the Plan shall be held in a Trust established pursuant to the Plan. Should the Participating Employer not pay the amount required by the Trustee hereunder, the benefits payable under the Plan to the Participating Employee shall be reduced by the amount of the Participating Employer's obligation that is outstanding.
7. The Participating Employer may terminate its participation in the Plan in respect of this Participating Employee at any time on condition that it has paid the Trustee all amounts that have been invoiced to the Participating Employer up to the date that the Participating Employer's termination of participation is communicated to the Administrator. A Participating Employer's decision to terminate its participation in respect of this Participating Employee has no bearing on its participation in respect of any other Participating Employee, if any exist.
8. The Participating Employee is not eligible for benefits under this Plan until the Participating Employee is accepted by the Administrator as such. This acceptance is evidenced by the signature and date affixed hereto by an authorized representative of the Administrator.
9. The Participating Employee shall cease to be covered for any or all of the benefits set forth in this Plan on the earlier of the:
(a) date the Participating Employee ceases to be an Employee of a Participating Employer, or
(b) date on which the Participating Employee communicates a desire to terminate benefits under the Plan, or
(c) date on which the Participating Employer communicates a desire to terminate responsibility for funding the benefits in respect of the Participating Employee, or
(d) termination of the Plan.
10. Neither the Participating Employee nor the Participating Employer have any other rights to the assets in the Plan other than those identified herein.
11. The Participating Employee and Participating Employer have each been given an opportunity to review The CAPCORP Planning (2003) Inc. Multi-Employer Health And Welfare Plan and each hereby consents to all terms and conditions thereof.

IN WITNESS WHEREOF this Participation Agreement has been executed:

By the Participating Employee:
Print Name Signature Date

On behalf of the Participating Employer:
Print Name Signature Date

On behalf of the Administrator, CAPCORP Planning (2003) Inc:

Principal Contact Signature Date
** Please note that the originals must be mailed in. **