Ms. Lynn Cross

Canadian Benefits Consulting Group Ltd.

2300 Yonge Street, Suite 3000

Toronto ON M4P 1E4

(date)

Dear Ms. Cross:

I wish to make application for the reimbursement of 41 weeks of LTD premiums paid by me prior to going on pension. I was advised to make application to your office and that you would forward to the Board of Trustees for their decision.

Enclosed is a letter from Canadian Pacific Pension Services with notification of my date of retirement and that I am receiving pension benefits.

Thank you.

Yours truly

(signature)

(name)

(address)