4. SUCCESSOR ANNUITANT Applicable for RIFs, LIFs, PRIFs, LRIFs and RLIFs only; not applicable for Quebec residents.
❑ Election of spouse as successor annuitant) I hereby elect that my spouse, named below, become the annuitant under my IA Clarington RIF/LIF/PRIF/
LRIF/RLIF in the event of my death, if he or she survives me. If my spouse becomes the annuitant, my IA Clarington RIF/LIF/PRIF/LRIF/RLIF shall remain
in force and no death benefit shall be payable until the death of my spouse. You cannot assign a contingent successor annuitant.
Please ensure that both sections 3 and 4 do not name the same person.
Name Social insurance number
Address City Province Postal code
5. CONTINGENT BENEFICIARY(IES) Not applicable in Quebec.
CAUTION: If more than one beneficiary has been designated in section 3 of this document, you cannot assign a contingent beneficiary.
If you are domiciled in a jurisdiction which by law permits you to validly designate a beneficiary other than by Will, you may designate a beneficiary
to receive the proceeds of your Plan in the event of your death before the maturity of your Plan. You may make, change or revoke your designation by
written notice signed by you in a form acceptable to, and received by, IA Clarington prior to your death. Any designation, amended designations or
revoked designations will be valid on the day following its receipt by the Trustee.
Contingent beneficiary(ies) are restricted to a single primary designation only and cannot be made where multiple primary designations exist. You can
however designate multiple contingent beneficiaries on a single beneficiary.
In the event of the death of one of the beneficiaries, the attributed share will be divided equally between the remaining beneficiaries.
Name Custodian (where applicable) Address
Social insurance
number Relationship
Allocation per
beneficiary
1.
%
2.
%
3.
%
4.
%
Total percentage must equal 100%*
%
* If the allocation per beneficiary is not specifically outlined each beneficiary will be entitled to an equal share of the account.
6. AUTHORIZATION
• I have read and agree to comply with the “Declaration of Trust” governing the plan set forth on the application used to open the account noted in section 3.
• I have read and agreed to comply with the Locked In addendum containing the applicable pension body for under which this account is governed.
• “I acknowledge that I am responsible for ensuring that the designations made in this document are valid and that there may be tax consequences
arising from them”
X
Signature of applicant/annuitant Date (DD/MM/YYYY)
X
Signature of joint applicant/annuitant (If required) Date (DD/MM/YYYY)
Important notes:
• A power of Attorney does not have the capacity to designate or change a beneficiary designation/testamentary disposition.
• The designations made on this form are valid only if signed and dated.
• The designation made on this form applies only to the account specified in section 2 of this document.
• The latest dated instrument in writing will take precedence in identifying the rightful beneficiary of a plan.
Please send completed original form to:
IA Clarington Investments Inc.
c/o Estates Department
522 University Avenue, Suite 700, Toronto, Ontario M5G 1Y7
888-860-9888 | funds@iaclarington.com | www.iaclarington.com
09/16/16