Miss Ms Sample Clauses

Miss Ms. Dr. Corporate Full Legal Name of Subscriber Address City Province Postal Code ( ) ( ) Home Telephone Business Telephone Email Address / / Social Insurance Number (SIN) Date of Birth (mm/dd/yyyy) Business Number (if corporate) Capacity or Title of Authorized Signatory (if corporate) 4B: Joint Subscriber Information Mr. Mrs. Miss Ms. Dr. Corporate Full Legal Name of Joint Subscriber Address City Province Postal Code ( ) ( ) Home Telephone Business Telephone Email Address Please initial if joint with right of survivorship is desired (both subscribers) Social Insurance Number (SIN)

Miss Ms. Dr. Corporate (Include Corp Search) City Province Postal Code ( ) Business Telephone Email Address / / Date of Birth (mm/dd/yyyy) Business Number (if corporate) Capacity or Title of Authorized Signatory (if corporate) Full Legal Name of Subscriber Address ( ) Home Telephone Social Insurance Number (SIN)

Miss Ms. ❍ Dr. Gender ❍ Male ❍ Female Successor Owner's Name (last, first, middle) Address City or Town Province Postal Code Date of Birth Relationship to Owner ❍ One-Life Income Stream (for Non-Registered Joint Annuitant Contracts please specify below the name of the Annuitant whose age will be used in determining income stream payments.) ❍ Two-Life Income Stream (for Two-Life Income Stream the Second Life must be the Annuitant’s spouse* and the Joint Annuitant on a Non-Registered Contract. For Registered Contracts, spousal details must be provided below) Gender ❍ Male ❍ Female Name (last, first, middle) Date of Birth Social Insurance Number (SIN) Country of Residency To remove this service please check here ❍ Primary Beneficiary Name(s) Relationship * Share (%) Contingent Beneficiary Name(s) (for the adjacent share) Relationship* Total 100% Name of Trustee(s) appointed for minor beneficiary(ies) (appointed administrator in Quebec) ❍ I have attached a letter of direction with additional/alternate/irrevocable beneficiary instructions. ❍ Cheque in the amount of $ A_M O U_N_T ❍ Transfer $ _A_M O U_N_T from another financial institution I _N_S_T I T_U T_I_O_N N A_M E (T2033/T2151/TD2 attached) ❍ Transfer $ _A_M O U_N_T from an existing CI account _C_I A_C C_O_U N_T N U_M B_E_R Fund Code Initial Sales Charge (if applicable) Gross Amount $ or % PAC Amount $ or % Fund Code Initial Sales Charge (if applicable) Gross Amount $ or % PAC Amount $ or % % % % % % % % % % % 12 Pre-Authorized Chequing Plan (PAC) Please complete Section 15 and specify the fund breakdown in the PAC amount column in Section 11. ❍ I (We) choose to receive plan payment confirmations. (All Owners receive annual statements detailing transactions in their Contract). PAC amount $ (Please ensure you meet the minimum required amount.) Payment Frequency (please select only one) Payment Start Date ❍ Weekly ❍ Bi-weekly ❍ Monthly ❍ Bi-monthly Y Y Y Y / M M / D D ❍ Quarterly ❍ Semi-Annually ❍ Annually X Y Y Y Y / M M / D D Signature(s) Date Signature(s) required if Depositor(s) is (are) other than the Owner(s) indicated in Section 4 and/or 5. For a joint bank account, all Depositors must sign if more than one signature is required on cheques issued against the account. By signing you confirm the banking information provided in Section 15 and that you have read and agree to the PAC terms and conditions outlined at the front of this Application.

Miss Ms. ❍ Dr. Gender ❍ Male ❍ Female Name (last, first, middle) Date of Birth Social Insurance Number (SIN) Country of Residency ❍ Joint Owners with Right of Survivorship (not applicable in Quebec) ❍ Only one signature required ❍ Joint Owners NOTE: If not selected both signatures are required. ❍ Mr. ❍ Mrs. ❍ Miss ❍ Ms. ❍ Dr. Gender ❍ Male ❍ Female Annuitant's Name (last, first, middle) Annuitant's Address (if different from Owner) City or Town Province Postal Code Date of Birth Country of Residency Relationship to Owner This section should only be completed in situations where the Annuitant is not the Owner.

Miss Ms. ❍ Dr. Gender ❍ Male ❍ Female The Owner is the Annuitant unless otherwise noted in Section 6 M A N D AT O R Y Owner's Name (last, first, middle) For entity applicants (corporations, partnerships, trusts, etc.) the Declaration of FATCA classification for an entity form (4545) is MANDATORY. M A N D AT O R Y Owner's Address City or Town M A N D AT O R Y Postal Code Country of Residency Y Y Y Y / M M / D D M A N D AT O R Y M A N D AT O R Y Province Residence Telephone Number Date of Birth Social Insurance Number (SIN) Owner's E-mail Address Mandatory for all Non-Registered Contracts - The following question should be answered only by an individual owner/applicant. Are you a U.S. resident for tax purposes (which includes a U.S. citizen)? ❍ Yes ❍ No If yes, provide a U.S. Taxpayer Identification Number (TIN) 5 Joint, In Trust For or Spousal Registered Plan Information Joint Owner and In Trust for Contracts are not applicable to Registered Contracts Subrogated Policyholders - Quebec residents only: If you (the Owner) and Joint Owner would like to name each other as subrogated policyholders please check here ❍ ❍ Mr. ❍ Mrs. ❍ Miss ❍ Ms. ❍ Dr. Gender ❍ Male ❍ Female Y Y Y Y / M M / D D M A N D AT O R Y Name (last, first, middle) M A N D AT O R Y M A N D AT O R Y Date of Birth Social Insurance Number (SIN) Country of Residency Joint Ownership Information - (Joint Non-Registered Contracts only) Joint Ownership Type: Signing Authority: ❍ Joint Owners with Right of Survivorship (not applicable in Quebec) ❍ Only one signature required ❍ Joint Owners NOTE: If not selected both signatures are required. Mandatory for all Non-Registered Contracts - The following question should be answered only by an individual owner/applicant. Are you a U.S. resident for tax purposes (which includes a U.S. citizen)? ❍ Yes ❍ No If yes, provide a U.S. Taxpayer Identification Number (TIN)

Miss Ms. ❍ Dr. Gender ❍ Male ❍ Female Beneficial Successor Owner's Name (last, first, middle) Relationship to beneficial Owner

Miss Ms. Dr. Corporate (Include Corp Search) Full Legal Name of Subscriber Address City Province Postal Code ( ) ( ) Home Telephone Business Telephone Email Address / / Social Insurance Number (SIN) Date of Birth (mm/dd/yyyy) Business Number (if corporate) Capacity or Title of Authorized Signatory (if corporate) 4B: Joint Subscriber Information Mr. Mrs. Miss Ms. Dr. Corporate Full Legal Name of Joint Subscriber Address City Province Postal Code ( ) ( ) Home Telephone Business Telephone Email Address / / Social Insurance Number (SIN) Date of Birth (mm/dd/yyyy) Please initial if joint with right of survivorship is desired (both subscribers)