Fillable IA Clarington Investments Inc.

Fill Online, Printable, Fillable, Blank IA Clarington Investments Inc. Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

IA Clarington Investments Inc.

On average this form takes 62 minutes to complete

The IA Clarington Investments Inc. form is 6 pages long and contains:

  • 8 signatures
  • 112 check-boxes
  • 164 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
IA Clarington Investments Inc.
IA Clarington GIF Individual Variable Annuity Contract
Please remember to:
1. Select your funds and fill in the amount to be invested.
2. Include your SIN number in section 4.
3. Attach a void cheque or direct deposit form
for section 8, if completed.
4. Sign the investment application in section 10
and section 11.
Please make cheques payable to
“IA Clarington Investments Inc.”
Mail to:
IA Clarington Investments Inc., c/o IFDS
1-30 Adelaide St E.,
Toronto, ON M5C 3G9
Fax this application to:
1-866-506-9884
Questions? Please contact us at 1-800-530-0204
Use this Segregated Fund
Investment Application to open
one of the following contracts:
• Non-registered (cash/open
contract)
• Retirement Savings Plan (RSP)
• Retirement Income Fund (RIF)
• Locked-in Retirement Account
(LIRA/LRSP)
• Restricted Locked-in RSP (RLSP)
• Life Income Fund (LIF)
• Locked-in Retirement Income
Fund (LRIF)
• Restricted Life Income Fund
(RLIF)
• Prescribed Retirement Income
Fund (PRIF)
INVESTED IN YOU.
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. GIF Contract | October 2019 3
1. REGISTRATION INFORMATION
MANDATORY
❑
New contract ❑ Existing contract # ❑ Transfer from existing IAC contract #
2. PLAN TYPE
MANDATORY for all contracts.
❑Non-Registered Plan - Individual*
Retirement savings plan (RSP)
❑Individual ❑Spousal
❑Locked-in retirement account (LIRA) ❑Locked-in RIF (LRIF)
❑Non-Registered Plan - Joint* ❑Life Income Fund (LIF) ❑Prescribed RIF (PRIF) – SK & MB only
❑Non-Registered Plan - In Trust For* ❑Restricted LIF (RLIF) – FED only ❑Restricted LSP (RLSP) – FED only
Retirement income fund (RIF)
❑Individual ❑Spousal
❑Non-Registered Plan - Formal Trust*
Pension jurisdiction:
❑Non-Registered Plan - Corporate*
*AML F51-208A Required
3. FINANCIAL ADVISOR INFORMATION
MANDATORY – Dealer and advisor information – complete this section for all accounts.
Financial advisor’s full name Advisor code/number Telephone number Fax number
Dealer name Dealer code/number Advisor email address
4. APPLICANT INFORMATION
MANDATORY Language preference: ❑ English ❑ French
A. Primary planholder information
❑Mr. ❑Mrs. ❑Ms. ❑Miss ❑Dr. ❑Corporation (Attach Corporate Resolution) ❑Formal Trust (attach Trust Documents)
Last name First name Initial(s)
Name of corporation/formal trust (Mandatory for a non- registered contract)
Principal occupation (Be specific. Generic terms such as "manager" or " consultant" are not sufficient.)
Address City Province Postal code
Residence phone number Business phone number Ext.
B. Secondary planholder information
❑
Spousal Contributor (For Spousal RSP and RIF only)
❑
Joint with rights of survivorship (Not applicable to Quebec)* *Who can provide authorization to make changes or place trades?
❑
In Trust For (not applicable for registered plans or Quebec residents)**
❑
Joint Tenants in Common*
❑
All accountholders must sign
❑
Any accountholder can sign
Last name First name Initial(s)
Address City
Province Postal code
Check here ❑ if you have attached a separate sheet with additional joint owner or In Trust For information.
In Trust For Accounts: Social Insurance Number to be used for tax reporting -
❑ Primary account owner (default) ❑ In trust for
**In Trust For designations are irrevocable.
C. Annuitant information – MANDATORY for ALL non-registered contracts.
The annuitant is the:
❑ Same as primary policyholder (section 4A) ❑ Same as joint holder (section 4B)
If this section is not completed, the primary policyholder named in section 4A will be deemed to be the annuitant. For registered contracts, the annuitant must be and will be the primary
policyholder named in section 4A. If the contract is held in a registered nominee or intermediary contract, the annuitant is automatically the registered nominee or intermediary contract holder.
❑ Mr. ❑ Mrs. ❑ Ms. ❑ Miss ❑ Dr.
Last name First name Initial(s)
Address City
Province Postal code
IA CLARINGTON SEGREGATED FUND INDIVIDUAL
ANNUITY VARIABLE CONTRACT
Issued by Industrial Alliance Insurance
and Financial Services Inc.
Administered by IA Clarington Investments Inc.
Date of birth (DD/MM/YYYY)
Social insurance number/ Business ID number
MANDATORY
Date of birth (DD/MM/YYYY)
Social insurance number
MANDATORY
Date of birth (DD/MM/YYYY)
Social insurance number
MANDATORY
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. GIF Contract | October 2019 4
5. BENEFICIARY DESIGNATION
OPTIONAL This section is only for contracts held in client’s name.
Notwithstanding any other beneficiary designation, for a contract held in client name and if the applicant acts as mandatory, trustee, or tutor or guardian, the beneficiary of the contract
is the legal heir. However, if the contract is held in a registered nominee or intermediary contract, the beneficiary of the contract is automatically the trustee of the registered nominee
or intermediary contract for the benefit of the holder of the registered nominee or intermediary contract. For a contract held in a nominee or intermediary contract (registered or non-
registered), any death benefit will be paid to the nominee or intermediary in trust for the beneficiary of the estate.
The policyholder reserves the right to revoke the beneficiary, unless the beneficiary designated is irrevocable. Written consent of irrevocable beneficiary is required for certain plan transactions.
Locked-In plans: Your spouse may be automatically entitled to benefits under a LIRA, a LIF or any locked-in contracts (see section 2) notwithstanding the beneficiary designation.
Quebec residents: If you name your spouse or civil union spouse as a beneficiary, the designation is considered irrevocable unless you check the box indicating that it is revocable.
Note: The beneficiary shares allocation will be split equally if not indicated.
Primary beneficiary’s full name Date of birth (DD/MM/YYYY) Social insurance number Relationship to primary owner Shares % Designation
%
❑
Revocable
❑
Irrevocable
%
❑
Revocable
❑
Irrevocable
Irrevocable beneficiary authorization – MANDATORY if "Irrevocable" designation is indicated
Note: future beneficiary designation can not be changed by the policyholder without the irrevocable beneficiary's consent.
X
Signature of irrevocable beneficiary Date (DD/MM/YYYY)
Check here
❑
if you have attached a separate sheet with additional primary beneficiary designations.
Contingent beneficiary – applicable if only ONE primary beneficiary is designated.
Contingent beneficiary’s full name Date of birth (DD/MM/YYYY) Social insurance number Relationship to primary owner
Check here
❑ if you have attached a separate sheet with additional contingent beneficiary designations.
6. INVESTMENT INSTRUCTIONS
MANDATORY for purchases and transfers (i.e. T2033, T2151).
❑ Transfer from another institution
(Attach a copy of the transfer form)
❑ One time PAC (Pre-authorized Contribution)
(Withdraw directly from a bank account)
VOID CHEQUE REQUIRED
Amount: $
❑ Upon receipt of this application in good order.
❑Specify date
(DD/MM/YYYY)
One-time purchase: If no date is provided, IAC will process
the one time purchase on the next available trade date
after reception of the request in good order.
FundSERV
wire order number
Fund code Investment amount
Amount
❑ $ or ❑ %
Front End Sales
charge 0–5%
Default is 0% if left
blank.
%
%
%
%
%
Check here
❑ if you have attached a separate sheet with additional investment instructions.
7. SYSTEMATIC PLANS
OPTIONAL VOID CHEQUE REQUIRED
A. PAC – Pre-authorized cheque payment (only applicable for non-registered and RSP contracts)
i. Start date:
ii. Frequency
❑ Monthly*
❑ Every other month
❑ Quarterly
❑ Semi-annually
❑ Annually
❑ Twice monthly (Provide 2 dates)**
1st start date:
2nd start date:
❑ Weekly ❑ Every other week
Choose the day of the week:
❑ Mon. ❑ Thurs.
❑ Tues. ❑ Fri.
❑ Wed.
I/We the applicant(s) of the account have read and acknowledge the pre-authorized debit agreement at the back of
this application. * If monthly frequency is selected and no start date is provided we will default your run date to the
15th of the month. **If twice monthly frequency is selected and the 2nd start date is not provided, we will default
your 2nd run date to 15 days following the date provided.
(DD/MM/YYYY)
iii. PAC allocation
Fund code Amount
Total: $
❑ % ❑ $
Sales charge
front-end* (0-5%)
Must = 100% of amount *FE = 0% unless stated otherwise
click to sign
signature
click to edit
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. GIF Contract | October 2019 5
B. SWP – Systematic withdrawal plan (only applicable for non-registered contracts)
i. Start date:
ii. Frequency
❑ Monthly*
❑ Every other month
❑ Quarterly
❑ Semi-annually
❑ Annually
❑ Twice monthly (Provide 2 dates)**
1st start date:
2nd start date:
❑ Weekly ❑ Every other week
Choose the day of the week:
❑ Mon. ❑ Thurs.
❑ Tues. ❑ Fri.
❑ Wed.
*If monthly frequency is selected and no start date is provided we will default your run date to the 15th of the
month. **If twice monthly frequency is selected and the 2nd start date is not provided, we will default your
2nd run date to 15 days following the date provided.
C. SSP – Systematic switch plan (for automatic switches between funds within your contract)
i. Start date:
ii. Frequency
❑ Monthly*
❑ Every other month
❑ Quarterly
❑ Semi-annually
❑ Annually
❑ Twice monthly (Provide 2 dates)**
1st start date:
2nd start date:
❑ Weekly ❑ Every other week
Choose the day of the week:
❑ Mon. ❑ Thurs.
❑ Tues. ❑ Fri.
❑ Wed.
Note: No switches available between USD and CDN units or between different sales charge option, such as DSC securities to low load securities and vice versa. Automatic switches are not allowed
for free unit switches into front end sales charge option. *If monthly frequency is selected and no start date is provided we will default your run date to the 15th of the month. **If twice monthly
frequency is selected and the 2nd start date is not provided, we will default your 2nd run date to 15 days following the date provided.
8. BANKING INFORMATION
MANDATORY
if section 6 (one time PAC), 7A, 7B or 9 (EFT payment) is completed.
❑ Please attach void cheque or direct deposit form or
existing bank account information on iA Clarington account - Account #
IMPORTANT: If attached banking information does NOT contain the iA Clarington accountholder’s name, please complete below authorization.
9. RIF PAYMENT PLAN
Applicable only to RIF, LIF, LRIF, RLIF, PRIF contracts.
i. Start date
If this section is not completed the default option will be the minimum payment based on your ACB paid annually on the 1st of December.
ii. Whose age is the minimum amount based on? If left blank, minimum amount calculation will be defaulted to the primary owner’s age.
❑ Primary owner’s age ❑ Spouse’s age – Provide date of birth (DD/MM/YYYY)
.
iii.
Amount requested (Choose one)
There is no minimum amount payable in the year the
account is funded.
Fund code RIF amount
❑ % ❑ $
❑ Minimum
❑ Maximum (LIF, LRIF, RLIF)
Specific Amount ❑ Gross ❑ Net
(All payments will be processed as gross, if “net” is not selected)
$
per payment
iv.
Withholding tax: I would like to
❑
apply
❑
increase the applicable withholding tax from the government prescribed amount to this percentage %.
Percentage amount indicated will be applied to both minimum and excess portion of the payment.
iii. SWP instructions
Fund code Amount: $
❑ Gross ❑ Net
❑ % ❑ $
Payment option – Choose
one of the following options
❑ EFT VOID CHEQUE REQUIRED
❑ Cheque via mail
❑ Deposit to IAC account
#
Must = 100% of amount
(DD/MM/YYYY)
iii. SSP instructions
From fund code To fund code SSP amount
Total: $
Dollar amounts only
(DD/MM/YYYY)
Only preprinted banking information is acceptable.
❑ Joint (void cheque is issued under primary owner’s name only – no further authorization is required)
❑ Third Party Personal (bank account does not belong to the iA Clarington accountholder)
X
Signature of bank account owner (if applicable) Date (DD/MM/YYYY)
❑ Business (corporate resolution required)
X
Signature of Business Signing Officer(s) (if applicable) Date (DD/MM/YYYY)
Frequency:
Choose one of the
following options.
Payment option:
Choose one of the following options.
❑ Monthly
❑ Every other month
❑ Quarterly
❑ Semi-annually
❑ Annually
❑ EFT Void Cheque Required
❑ Cheque via mail
❑ Deposit to IAC account #
If cheque is selected for payment instruction, it will
be mailed to the address indicated in section 4A
of this application form.
(DD/MM/YYYY)
click to sign
signature
click to edit
click to sign
signature
click to edit
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. GIF Contract | December 2017 6
10. ACKNOWLEDGEMENT & AUTHORIZATION
MANDATORY for completion by all account owners.
A. To be completed by policyholder and annuitant
I, the policyholder and/or the annuitant (if different), hereby:
• Acknowledge that the issuer of the contract and guarantor of the guarantees is Industrial Alliance Insurance and Financial Services Inc.;
• Declare that all statements and answers made by me in this application are fully complete and true;
• Acknowledge that the provisions enclosed in this application are an integral part of the contract;
• Confirm that I have requested that this application be drafted in English language only. Par les présentes, je confirme avoir demandé que la présente proposition soit rédigée en anglais uniquement;
• Consent to the collection, use and disclosure of my personal information by the company in the ways and for the purposes identified in the “File and Personal Information” section of the
contract;
• Acknowledge receipt of the IA Clarington Guaranteed Investment Funds (GIF) document which includes the IA Clarington GIF Individual Variable Annuity Contract and the Information Folder
describing the key features of the contract and including the fund facts sheets for GIF;
• Declare that I have been directed by my Agent to the funds I am purchasing;
• Advise Industrial Alliance Insurance and Financial Services Inc. that the nominee/intermediary named in this application, if any, is my duly authorized agent for all matters related to this
contract;
• Authorize Industrial Alliance Insurance and Financial Services Inc. to deliver the contract and any other documents or correspondence to the nominee/intermediary and to accept instruction
from the nominee/intermediary to execute the financial and non-financial transactions including, but not limited to, subscribing to an annuity contract, surrenders and transfers of investments
in accordance with my instruction and contract provisions; and
• Authorize Industrial Alliance and Financial Services Inc. to accept premiums for investment in this contract and to pay partial and total surrender amounts requested by the nominee/
intermediary directly to the nominee/intermediary;
I understand Industrial Alliance Insurance and Financial Services Inc. shall not be liable for instructions provided by the nominee/intermediary.
If I selected retirement saving plan in section 2, I hereby request that this contract be registered as a registered retirement saving plan under the Income Tax Act (Canada) and any applicable
provincial legislation.
If I selected retirement income fund in section 2, I hereby request that this contract be registered as a registered retirement income fund under the Income Tax Act (Canada) and any applicable
provincial legislation.
Signed at
this
of
20
.
City Province day month
X X
Signature of policyholder Date (DD/MM/YYYY) Signature of joint policyholder
Date (DD/MM/YYYY)
X
Signature of annuitant (if different than the policyholder) Date (DD/MM/YYYY)
B. Annuitant’s spousal consent – MANDATORY for LIF contracts under ON, NS, and NL pension jurisdiction
This annuitant’s spouse’s consent is required in order to open a LIF/LRIF contract governed under Ontario, Nova Scotia, and Newfoundland pension jurisdiction, if the funds being transferred
into this contract are originating from a LIRA/LRSP or RPP. I am the spouse of the annuitant (named in section 4C) of this application and I consent to the purchase of this LIF/LRIF contract.
X
Full name of annuitant’s spouse Signature of annuitant’s spouse Date (DD/MM/YYYY)
11. AGENT/REPRESENTATIVE’S DISCLOSURE
MANDATORY
To be completed by the sales agent/representative
By signing below, I confirm the following:
• That I am a duly authorized licensed agent;
• That I have examined the original, valid, government-issued identification documentation for the policyholder and the joint holder (if any) and validated the annuitant’s date of birth
• That I have witnessed all signatures
• That I have provided a disclosure statement to the policyholder and joint policyholder (if any) which discloses:
• The company or companies I represent and my relationship with them
• That I receive compensation (such as commissions) for the sale of life insurance and savings products and that I may receive other compensation such as bonuses, invitations to conferences
or other incentives; and
• Any conflicts of interest that I may have with respect to this transaction; and
• That if required, I have duly completed and signed a form F51-208A and I have attached it to this application.
If the contract is held in a nominee or intermediary contract, I hereby:
• Confirm to be the duly authorized agent of the nominee or intermediary;
• Confirm that, if the contract is issued to be held in a registered nominee or intermediary contract, the nominee or intermediary is the duly authorized agent of the trustee of the registered
nominee or intermediary contract and that this contract is an authorized investment for the registered nominee or intermediary contract; and
• Declare any conflicts of interest that I may have with respect to this transaction.
X
Signature of agent (representative)/witness signature Date (DD/MM/YYYY)
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
JOINT POLICYHOLDER DISCLOSURE
By designating each other Subrogated Policyholders (for the province of Quebec) or by selecting Joint with Rights of Survivorship (for all provinces and territories except Quebec), the Joint Policyholders
acknowledge and agree that, upon the death of one or the other, whichever is first, the deceased’s rights and obligations pursuant to the contract will pass automatically to the other Joint Policyholder
(if the deceased is not the annuitant). If no Subrogated Policyholder is designated or if the option Joint without Rights of Survivorship is selected, the Joint Policyholders agree that their respective
rights and obligations pursuant to the contract will automatically form part of their estate upon their death (if the deceased is not the annuitant). For all provinces and territories except Quebec: if no
instruction is provided, the option Joint with Rights of Survivorship will apply. The transfer of ownership of the contract may have tax implications and it is suggested that the Policyholder consults his
tax advisor concerning same.
PRE-AUTHORIZED CHEQUE PAYMENT/ELECTRONIC FUNDS TRANSFER (PAC/EFT) AGREEMENT
In this PAC/EFT Agreement, each owner is referred to as “I” and makes the following statements with respect to himself or herself:
• I authorize Industrial Alliance Insurance and Financial Services Inc. (the “Company”) and the financial institution designated (or any other financial institution I may authorize at any time) to
begin deductions as per my instructions for regular recurring payments and/or a one-time payment from time to time, for payment of all premiums, deposits, instalments and charges arising
from the Contract;
• Regular payments will be debited form my specified bank account based on the date and/or frequency I have chosen, whereas the Company will obtain my authorization for any one-time payment that
can be debited from my account on any other date;
• I agree that, for the purpose of this PAC agreement, all PACs from my account will be treated either as Personal or Business depending on the choice I’ve made in Section 8 of this Contract;
• I waive the right to receive pre-notification of an increase or a decrease in the amount to be debited or a change in the date and/or frequency of these payments;
• I agree that the Company is not required to provide me with written notice of a change in the PAC amount that is made as a result of my request;
• If a PAC is dishonoured for any reason such as, but not limited to, insufficient funds (“NSF”), a stop payment or a closed account, the Company is authorized to re-submit the payment. Any charges
incurred by the Company as a result of the dishonoured PAC will be added to the subsequent PAC;
• I may cancel or modify this PAC Agreement at any time, subject to providing the Company with (30) days notice in writing. To obtain a sample cancellation form or for more information on my right to
cancel the PAC agreement, I may contact my financial institution or visit www.cdnpay.ca regarding Rule H1 – Pre-authorized debits (PADs);
• Any cancellation of this PAC agreement will not affect my contract(s) for financial services so long as payment is provided by an alternative method;
• The Company will not assign this PAC Agreement without providing me with written notice of the assignment, any time prior to the next PAC;
• I have certain recourse rights if any PAC does not comply with this PAC Agreement. For example, I have the right to receive reimbursement for any PAC that is not authorized or is not consistent with
this PAC agreement. To obtain more information on my recourse rights, I should contact my financial institution or visit www.cdnpay.ca regarding Rule H1 – Pre-authorized debits (PADs); and
• Before the Company debits the first PAC/EFT payment, it must receive all required documents, duly completed, and be allowed a reasonable period of time to complete its administrative processes.
GIF Contract | December 2017 7
Administration
IA Clarington Investments Inc.
c/o International Financial Data
Services (Canada) Limited
30 Adelaide Street East, Suite 1,
Toronto, ON M5C 3G9
Toronto Office
522 University Avenue, Suite 700,
Toronto, ON M5G 1Y7
Phone: 888.860.9888
Fax: 416.860.9884
Client Services
Phone: 800.530.0204
Fax: 866.506.9884
funds@iaclarington.com
iA Clarington Investments
Trademarks displayed herein that are not owned by Industrial Alliance Insurance and Financial Services Inc. are the property of and trademarked by the
corresponding company and are used for illustrative purposes only. The iA Clarington Funds are managed by IA Clarington Investments Inc. iA Clarington
and the iA Clarington logo are trademarks of Industrial Alliance Insurance and Financial Services Inc. and are used under license.
iaclarington.com
INVESTED IN YOU.
(20-0355) 03/20-010072-11
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

IA Clarington Investments Inc.

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document