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BUSINESS INFORMATION FORM This form must be completed

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a) Corporation
Applicant/Owner Name (first, last) Application/Policy Number
This form must be completed when the owner of the policy is a business or organization.
Please complete all applicable sections.
1. Entity Identification
Please complete the applicable section:
a) Corporation
b) Sole Proprietor/Partnerships/Associations/Unions
c) Not For Profit Organization
d) Estate or Trust
I have attached the following evidence of existence (choose at least one):
a copy of articles of incorporation business license registration of business name or corporate search
List the name(s) of the corporation’s directors:
BUSINESS INFORMATION FORM
Head Office
One Westmount Road North
P.O. Box 1603 Stn. Waterloo, Waterloo, Ontario N2J 4C7
TF 1.800.668.4095 T 519.886. 5210 F 519.8 83. 74 04
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 1 of 9
Full Legal Corporate Name Business Number or Quebec Enterprise Number
Incorporation Number Jurisdiction (federal/provincial)
Address (street number and name) City
Province Postal Code Email Address
Describe principal business activity (if a holding company, describe the nature of businesses held)
Do you carry on business under any other names? Please list:
Name Name
Name Name
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 2 of 9
1. Entity Identification (continued)
b) Sole Proprietor/Partnerships/Associations/Unions
Full Name of Entity Business Number or Quebec Enterprise Number
Registration Number (if applicable) Jurisdiction (federal/provincial)
Address (street number and name) City
Province Postal Code Email Address
Describe principal business activity (if a holding company, describe the nature of businesses held)
Name Name
Name Name
List the name(s) of the organization’s principals/directors:
Please attach as applicable:
Sole Proprietor and Partnership: Union:
Copy of business license or registration of business name Copy of most recent collective agreement
(Not required if name of company is the exact name of the proprietor)
Association: Limited Liability or Other Corporation:
Copy of the bylaws, regulations, association agreement/nominate contract (PQ) Articles of incorporation
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 3 of 9
1. Entity Identification (continued)
c) Not for Profit Organization
(Incorporated or Non-Incorporated)
d) Estate or Trust
Complete the following information for all trustees/executors, beneficiaries and settlors of the Estate or Trust:
Full Name of Not for Profit Organization
Incorporation Number (if applicable) Jurisdiction (federal/provincial)
Address (street number and name) City
Province Postal Code Email Address
Describe principal business activity (if a holding company, describe the nature of businesses held)
I have attached one of the following (if applicable):
a copy of articles of incorporation business license registration of business name or corporate search
Does the organization solicit public contributions? Yes No
Is the organization registered with Canada Revenue Agency? Yes No
If yes, Registration Number
Name Name
Name Name
List the name(s) of the organization’s directors:
Select as applicable: Name Address
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
Trustee/Executor Beneficiary Settlor
I have attached evidence of existence (choose at least one):
Trust Agreement/Deed Will/Estate Documents
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 4 of 9
2. Beneficial Ownership
A beneficial owner is an individual who owns or controls, directly or indirectly, 25% or more of the business/entity. Complete the
following for each beneficial owner.
No person owns or controls, directly or indirectly, 25% or more of the above business/entity.
Name (first, middle initial, last) Residential Address (street number and name)
City Province Postal Code
Name
(first, middle initial, last) Residential Address (street number and name)
City Province Postal Code
Name
(first, middle initial, last) Residential Address (street number and name)
City Province Postal Code
If you were unable to provide the information for any of the beneficial owners, please explain why:
3. Identity Verification
Use this section to verify the identification of the individual(s) who has the authority to sign or provide direction on behalf of the
corporate/non-corporate entities for the above application/contract number.
Name (first, middle initial, last)
Residence Address
Please choose one of the following Verification of Identification methods (A or B):
A) In Person:
Your Canadian identification must be verified by your advisor. Choose one of the following: driver’s license, provincial photo card
(excluding provincial health cards), passport, citizenship card, permanent resident card, or certificate of Indian status card.
Confirmation by advisor:
I, the advisor, have held and viewed the original photo identification. Provide details:
Identification Type Identification Number Issuing Jurisdiction/Country
Expiry Date
(dd/mm/yyyy)
Date Advisor Verified
(dd/mm/yyyy)
B) Non Face-to-Face
Use this method when the advisor is not physically present to verify the identification.
I, the signing officer identified above, consent to Equitable Life verifying my identity through a third party service provider.
Date of Birth (dd/mm/yyyy) Residence Phone Number
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 5 of 9
3. Identity Verification (continued)
Name (first, middle initial, last)
Residence Address
Please choose one of the following Verification of Identification methods (A or B):
A) In Person:
Your Canadian identification must be verified by your advisor. Choose one of the following: driver’s license, provincial photo card
(excluding provincial health cards), passport, citizenship card, permanent resident card, or certificate of Indian status card.
Confirmation by advisor:
I, the advisor, have held and viewed the original photo identification. Provide details:
Identification Type Identification Number Issuing Jurisdiction/Country
Expiry Date
(dd/mm/yyyy)
Date Advisor Verified
(dd/mm/yyyy)
B) Non Face-to-Face
Use this method when the advisor is not physically present to verify the identification.
I, the signing officer identified above, consent to Equitable Life verifying my identity through a third party service provider.
Name (first, middle initial, last)
Residence Address
Please choose one of the following Verification of Identification methods (A or B):
A) In Person:
Your Canadian identification must be verified by your advisor. Choose one of the following: driver’s license, provincial photo card
(excluding provincial health cards), passport, citizenship card, permanent resident card, or certificate of Indian status card.
Confirmation by advisor:
I, the advisor, have held and viewed the original photo identification. Provide details:
Identification Type Identification Number Issuing Jurisdiction/Country
Expiry Date
(dd/mm/yyyy)
Date Advisor Verified
(dd/mm/yyyy)
B) Non Face-to-Face
Use this method when the advisor is not physically present to verify the identification.
I, the signing officer identified above, consent to Equitable Life verifying my identity through a third party service provider.
Date of Birth (dd/mm/yyyy) Residence Phone Number
Date of Birth (dd/mm/yyyy) Residence Phone Number
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 6 of 9
4. Declaration of Tax Residence
Check all of the options that apply to the entity.
The entity is a tax resident of Canada. If the entity is a trust, give its trust account number.
Trust account number: T-
The entity is a tax resident of the United States.
The entity is a tax resident of a jurisdiction other than Canada or the United States.
Jurisdiction of tax residence: Taxpayer identification number:
If the entity does not have a TIN for a specific jurisdiction, give the reason using one of these choices:
a) The entity will apply or has applied for a TIN but has not yet received it.
b) The entity’s jurisdiction of tax residence does not issue TINs to its residents.
c) Other reason:
5. Entity Classification
For more information on classifying the entity, consult with the entity’s tax or other advisor, or view
http://www.cra-arc.gc.ca/tx/nnrsdnts/nhncdrprtng/ntts-eng.html.
Check all of the appropriate boxes.
Section 5.1 – Is the entity a financial institution?
No. Go to section 5.3. Yes. Give the entity’s global intermediary identification number (GIIN) and go to section 5.2.
GIIN: If the entity does not have a GIIN, give the reason why.
Section 5.2 – Does the financial institution meet all of these criteria?
• It is a resident of a non-participating jurisdiction (see cra.gc.ca/tx/bsnss/tpcs/slps/fnncl/crs/jrsdctns-eng.html for the List of
participating jurisdictions).
• At least 50% of its gross income is from investing or trading in financial assets.
• It is managed by another financial institution.
No. Go to section 7. Yes. Complete section 6 - Controlling Persons.
Section 5.3 – Is the entity a specified United States person?
No. Go to section 5.4. Yes. Give the TIN from the United States and go to section 5.4.
TIN from the United States
If you do not have a TIN from the United States, have you applied for one? Yes No.
Section 5.4 – Check the option that best describes the entity:
The entity is a corporation with shares that regularly trade on
an established securities market. It can also be a corporation
related to that corporation. If this is the case, go to section 7.
The entity is engaged in an active trade or business—less
than 50% of its gross income is passive income and less than
50% of its assets produce passive income. If this is the case,
go to section 7.
The entity is a government, a central bank or an international
organization (or an agency of one). If this is the case, go to
section 7.
The entity is an active non-financial entity other than one
described in the three previous options. If this is the case, go
to section 7.
The entity is a passive non-financial entity. If this is the case,
complete section 6 - Controlling Persons.
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 7 of 9
6. Information About Controlling Persons
Complete this section if the answer(s) you indicated in section 5.2 or 5.4 directed you to complete “section 6 - Controlling
Persons”. Otherwise, proceed to section 7 - Applicant/Policy Owner Declaration and Signatures.
Identify the entity’s controlling persons:
• for trusts, the controlling persons are all trustees, beneficiaries and settlors;
• for corporations and other entities, controlling persons are all individuals who own or control, directly or indirectly, 25% or
more of the entity;
• if there is no controlling person, provide information about the most senior officer of the entity.
Attach a separate list if you need to enter the information of more than two controlling persons.
Controlling person 1
Last name First name and initial(s) Date of birth (dd/mm/yyyy)
Type of controlling person (choose one):
Direct owner of a corporation or other legal person
Indirect owner of a corporation or other legal person (through an
intermediary)
Director or senior official of a corporation or other legal person
Settlor of a trust
Trustee of a trust
Protector of a trust
Beneficiary of a trust
Other controlling person of a trust.
Equivalent to a settlor of a legal arrangement other than a trust
Equivalent to a trustee of a legal arrangement other than a trust
Equivalent to a protector of a legal arrangement other than a trust
Equivalent to a beneficiary of a legal arrangement other than a trust
Other controlling person of a legal arrangement other than a trust
Permanent residence address
Apartment number – street number and name City
Province, territory, state, or sub-entity Country or jurisdiction Postal or ZIP code
Mailing address (only if different from the permanent residence address)
Apartment number – street number and name City
Province, territory, state, or sub-entity Country or jurisdiction Postal or ZIP code
Declaration of tax residence
Check all of the options that apply to you.
The controlling person is a tax resident of Canada. If you checked this box and the controlling person is also a citizen of the United States
or a tax resident of any country other than Canada, provide the controlling person’s social insurance number.
Social insurance number (SIN):
The controlling person is a tax resident or a citizen of the United States. If you checked this box, give the controlling person’s taxpayer
identification number (TIN) from the United States.
TIN from the United States:
If the controlling person does not have a TIN from the United States, has that person applied for one? Yes No
The controlling person is a tax resident of a jurisdiction other than Canada or the United States. If you checked this box, provide the
following information:
Jurisdiction of tax residence: Taxpayer identification number:
If the entity does not have a TIN for a specific jurisdiction, give the reason using one of these choices:
a) I will apply or have applied for a TIN but have not yet received it.
b) My jurisdiction of tax residence does not issue TINs to its residents.
c) Other reason:
6. Information About Controlling Persons (continued)
Controlling person 2
Last name First name and initial(s) Date of birth (dd/mm/yyyy)
Type of controlling person (choose one):
Direct owner of a corporation or other legal person
Indirect owner of a corporation or other legal person (through an
intermediary)
Director or senior official of a corporation or other legal person
Settlor of a trust
Trustee of a trust
Protector of a trust
Beneficiary of a trust
Other controlling person of a trust
Equivalent to a settlor of a legal arrangement other than a trust
Equivalent to a trustee of a legal arrangement other than a trust
Equivalent to a protector of a legal arrangement other than a trust
Equivalent to a beneficiary of a legal arrangement other than a trust
Other controlling person of a legal arrangement other than a trust
Permanent residence address
Apartment number – street number and name City
Province, territory, state, or sub-entity Country or jurisdiction Postal or ZIP code
Mailing address (only if different from the permanent residence address)
Apartment number – street number and name City
Province, territory, state, or sub-entity Country or jurisdiction Postal or ZIP code
Declaration of tax residence
Check all of the options that apply to you.
The controlling person is a tax resident of Canada. If you checked this box and the controlling person is also a citizen of the United States
or a tax resident of any country other than Canada, provide the controlling person’s social insurance number.
Social insurance number (SIN):
The controlling person is a tax resident or a citizen of the United States. If you checked this box, give the controlling person’s taxpayer
identification number (TIN) from the United States.
TIN from the United States:
If the controlling person does not have a TIN from the United States, has that person applied for one? Yes No
The controlling person is a tax resident of a jurisdiction other than Canada or the United States. If you checked this box, provide the
following information:
Jurisdiction of tax residence: Taxpayer identification number:
If the entity does not have a TIN for a specific jurisdiction, give the reason using one of these choices:
a) I will apply or have applied for a TIN but have not yet received it.
b) My jurisdiction of tax residence does not issue TINs to its residents.
c) Other reason:
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 8 of 9
BUSINESS INFORMATION FORM
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
594(2019/04/04) Page 9 of 9
Please note: Equitable Life
®
cannot ensure the privacy and confidentiality of any information sent through the internet because e-mail may be
vulnerable to interception. As a result, Equitable Life is not responsible for any loss or damages you may incur if your information is intercepted
and misused. If you would prefer to submit your information by another means, please contact us at 1.800.668.4095.
7. Applicant/Policy Owner Declaration and Signatures
In this section, “you” and “your” mean the signing officers or trustees signing below.
By signing below:
• You declare that you are authorized to sign on behalf of the policy owner.
• You certify that the information provided on this form is current, correct and complete.
• You agree to notify Equitable Life within 30 days of a change to any of the information provided on this form.
First Name Middle initial Last name
Signature of signing officer or trustee Title Date (dd-mm-yyyy)
First Name Middle initial Last name
Signature of signing officer or trustee Title Date (dd-mm-yyyy)
First Name Middle initial Last name
Signature of signing officer or trustee Title Date
(dd-mm-yyyy)
8. Advisor Declaration
To the best of my knowledge, the information provided is complete and true.
Advisor Signature Date (dd/mm/yyyy) Advisor Code
Note: If you own this policy you can not sign as the advisor. If applicable, this declaration must be completed by another
licensed and contracted advisor.
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Completed 8 March 2022

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