Instructions for completing this form
In this form, the terms “you”, “your”, “my” and “owner” refer to the policy owner(s). The terms “we”, “our” and “us” refer to
The Equitable Life Insurance Company of Canada (Equitable Life). An advisor can complete this form if there is “Limited Trading
Authorization” on file. This will void the current and any previous reset guarantees.
1. Contract details
Name of Policy Owner(s)
Policy number(s)
693SEL(2020/02/24) Page 1 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
INVESTMENT DIRECTION – PIVOTAL SELECT
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 519.883.7404
www.equitable.ca
2. Political positions (for non-registered and only when deposit is equal to or greater than $100,000)
For the purposes of this question:
• “Payor” means the person who is making the payment(s) on the policy.
• “Close relative” means the Payor’s spouse, sibling, parent, spouse’s parent, child, or child’s spouse.
• “Close associate” means an individual who is closely connected to the Payor for personal or business reasons.
Does the Payor, any of the Payor’s close relatives or any of the Payor’s close associates hold, or have they ever held, any of the
positions listed below?
No – go to Section 3 Yes – indicate the political position below
Position in Canada or in another country
Note: For positions in Canada, list only the positions held in the past five years. For all other countries, list all such positions that have ever been held.
Head of state or head of government (including
governor general and lieutenant governor)
President of a state-owned company or bank
(including a corporation that is wholly owned
by a federal or provincial government)
Member of the executive council of government
or member of a legislature (including the Senate,
House of Commons or a provincial legislature)
Head of a government agency
Judge (in Canada only, must be a judge of an
appeal court)
Head of an international organization that is established by the
governments of countries or the head of an institution of any
such organization
Deputy minister (or equivalent)
Leader or president of a political party in a legislature
Ambassador or ambassador’s attaché or counsellor
Military general (or higher rank)
Mayor of a Canadian municipality (does not include mayors in
countries other than Canada)
If you answered “Yes” to the question above, complete the following information:
What is the name of the person who holds or held
the position?
What is the title of the position held?
Position held from:
(starting year)
to
(ending year)
In what country was the position held?
With what organization, government or institution was
the position held?
How is this person related to the Payor?
The person is the Payor
Close relative (relationship):
Close associate (relationship):
Note: If more than one person has held a position, complete section 1 and 2 of the “Additional/Updated Customer Information Form # 1027”
for each additional person.
693SEL(2020/02/24) Page 2 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
INVESTMENT DIRECTION – PIVOTAL SELECT
3. Premium allocation for segregated funds - Investment Class (75/75)
I/We request that: a) £ Only this premium of $ be allocated as follows:
b) £ This premium of $ and all future premiums be allocated as follows:
Please check in front of the elected fund code(s). Based on our administrative rules, Low Load and DSC units may not be held
within the same contract. Total percentage allocation must equal 100%.
Investment Class (75/75)
Fund
Class
Segregated Funds %/$ DSC NL LL NL-CB
Fixed
Income
EL Active Canadian Bond Fund Select
602 702 1202 3002
EL Mackenzie Unconstrained Fixed Income Fund Select
646 746 1246 3046
EL Money Market Fund Select
605 705 1205 3005
EL Invesco Global Bond Fund Select
611 711 1211 3011
Balanced and Asset Allocation
EL Bissett Monthly Income and Growth Fund Select
642 742 1242 3042
EL Dynamic U.S. Monthly Income Fund Select
655 755 1255 3055
EL Dynamic Value Balanced Fund Select
633 733 1233 3033
EL Mackenzie Canadian Growth Balanced Fund Select
635 735 1235 3035
EL Mackenzie Income Fund Select 641 741 1241 3041
EL Mackenzie Ivy Canadian Balanced Fund Select
654 754 1254 3054
EL Mackenzie Ivy Global Balanced Fund Select
648 748 1248 3048
EL Invesco Diversified Yield Fund Select
651 751 1251 3051
EL Invesco Global Balanced Fund Select
619 719 1219 3019
Domestic Equity
EL Bissett Canadian Equity Fund Select
640 740 1240 3040
EL Bissett Dividend Income Fund Select
616 716 1216 3016
EL Low Volatility Canadian Equity Fund Select
609 709 1209 3009
EL Canadian Stock Fund Select
603 703 1203 3003
EL Dynamic Equity Income Fund Select
649 749 1249 3049
Foreign Equity
EL Dynamic American Fund Select
647 747 1247 3047
EL Dynamic Global Discovery Fund Select
645 745 1245 3045
EL Mackenzie Global Small Cap Growth Fund Select
617 717 1217 3017
EL Invesco Europlus Fund Select
618 718 1218 3018
EL Invesco Global Companies Fund Select
650 750 1250 3050
EL Invesco International Companies Fund Select
630 730 1230 3030
Portfolio funds
EL Active Balanced Growth Portfolio Select
639 739 1239 3039
EL Active Balanced Income Portfolio Select
638 738 1238 3038
EL Active Balanced Portfolio Select
637 737 1237 3037
EL Invesco Intactive Balanced Growth Portfolio Select
644 744 1244 3044
EL Invesco Intactive Balanced Income Portfolio Select
643 743 1243 3043
EL Quotential Balanced Growth Portfolio Select
622 722 1222 3022
EL Quotential Balanced Income Portfolio Select
621 721 1221 3021
EL Quotential Diversified Equity Portfolio Select
624 724 1224 3024
EL Quotential Diversified Income Portfolio Select
623 723 1223 3023
EL Quotential Growth Portfolio Select
625 725 1225 3025
Based on our administrative rules, DSC, LL and NL-CB units may not be held within the same contract
EL = Equitable Life DSC = Deferred Sales Charge (Sales charge applies to client) NL = No Load LL = Low Load (Sales charge applies to client)
NL-CB = No Load CB (Chargeback to advisor)
693SEL(2020/02/24) Page 3 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
3. Premium allocation for segregated funds - Estate Class (75/100)
I/We request that: a) £ Only this premium of $ be allocated as follows:
b) £ This premium of $ and all future premiums be allocated as follows:
Please check in front of the elected fund code(s). Based on our administrative rules, Low Load and DSC units may not be held
within the same contract. Total percentage allocation must equal 100%.
INVESTMENT DIRECTION – PIVOTAL SELECT
Estate Class (75/100)
Fund
Class
Segregated Funds %/$ DSC NL LL NL-CB
Fixed
Income
EL Active Canadian Bond Fund Select
802 902 1302 3102
EL Mackenzie Unconstrained Fixed Income Fund Select
846 946 1346 3146
EL Money Market Fund Select
805 905 1305 3105
EL Invesco Global Bond Fund Select
811 911 1311 3111
Balanced and Asset Allocation
EL Bissett Monthly Income and Growth Fund Select
842 942 1342 3142
EL Dynamic U.S. Monthly Income Fund Select
855 955 1355 3155
EL Dynamic Value Balanced Fund Select
833 933 1333 3133
EL Mackenzie Canadian Growth Balanced Fund Select
835 935 1335 3135
EL Mackenzie Income Fund Select 841 941 1341 3141
EL Mackenzie Ivy Canadian Balanced Fund Select
854 954 1354 3154
EL Mackenzie Ivy Global Balanced Fund Select
848 948 1348 3148
EL Invesco Diversified Yield Fund Select
851 951 1351 3151
EL Invesco Global Balanced Fund Select
819 919 1319 3119
Domestic Equity
EL Bissett Canadian Equity Fund Select
840 940 1340 3140
EL Bissett Dividend Income Fund Select
816 916 1316 3116
EL Low Volatility Canadian Equity Fund Select
809 909 1309 3109
EL Canadian Stock Fund Select
803 903 1303 3103
EL Dynamic Equity Income Fund Select
849 949 1349 3149
Foreign Equity
EL Dynamic American Fund Select
847 947 1347 3147
EL Dynamic Global Discovery Fund Select
845 945 1345 3145
EL Mackenzie Global Small Cap Growth Fund Select
817 917 1317 3117
EL Invesco Europlus Fund Select
818 918 1318 3118
EL Invesco Global Companies Fund Select
850 950 1350 3150
EL Invesco International Companies Fund Select
830 930 1330 3130
Portfolio funds
EL Active Balanced Growth Portfolio Select
839 939 1339 3139
EL Active Balanced Income Portfolio Select
838 938 1338 3138
EL Active Balanced Portfolio Select
837 937 1337 3137
EL Invesco Intactive Balanced Growth Portfolio Select
844 944 1344 3144
EL Invesco Intactive Balanced Income Portfolio Select
843 943 1343 3143
EL Quotential Balanced Growth Portfolio Select
822 922 1322 3122
EL Quotential Balanced Income Portfolio Select
821 921 1321 3121
EL Quotential Diversified Equity Portfolio Select
824 924 1324 3124
EL Quotential Diversified Income Portfolio Select
823 923 1323 3123
EL Quotential Growth Portfolio Select
825 925 1325 3125
Based on our administrative rules, DSC, LL and NL-CB units may not be held within the same contract
EL = Equitable Life DSC = Deferred Sales Charge (Sales charge applies to client) NL = No Load LL = Low Load (Sales charge applies to client)
NL-CB = No Load CB (Chargeback to advisor)
693SEL(2020/02/24) Page 4 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
3. Premium allocation for segregated funds - Protection Class (100/100)
I/We request that: a) £ Only this premium of $ be allocated as follows:
b) £ This premium of $ and all future premiums be allocated as follows:
Please check in front of the elected fund code(s). Based on our administrative rules, Low Load and DSC units may not be held
within the same contract. Total percentage allocation must equal 100%.
INVESTMENT DIRECTION – PIVOTAL SELECT
Protection Class (100/100)
Fund
Class
Segregated Funds %/$ DSC NL LL NL-CB
Fixed
Income
EL Active Canadian Bond Fund Select
1002 1102 1402 3202
EL Mackenzie Unconstrained Fixed Income Fund Select
1046 1146 1446 3246
EL Money Market Fund Select
1005 1105 1405 3205
EL Invesco Global Bond Fund Select
1011 1111 1411 3211
Balanced and Asset Allocation
EL Bissett Monthly Income and Growth Fund Select
1042 1142 1442 3242
EL Dynamic U.S. Monthly Income Fund Select
1055 1155 1455 3255
EL Dynamic Value Balanced Fund Select
1033 1133 1433 3233
EL Mackenzie Canadian Growth Balanced Fund Select
1035 1135 1435 3235
EL Mackenzie Income Fund Select 1041 1141 1441 3241
EL Mackenzie Ivy Canadian Balanced Fund Select
1054 1154 1454 3254
EL Mackenzie Ivy Global Balanced Fund Select
1048 1148 1448 3248
EL Invesco Diversified Yield Fund Select
1051 1151 1451 3251
EL Invesco Global Balanced Fund Select
1019 1119 1419 3219
Domestic Equity
EL Bissett Canadian Equity Fund Select
1040 1140 1440 3240
EL Bissett Dividend Income Fund Select
1016 1116 1416 3216
EL Low Volatility Canadian Equity Fund Select
1009 1109 1409 3209
EL Canadian Stock Fund Select
1003 1103 1403 3203
EL Dynamic Equity Income Fund Select
1049 1149 1449 3249
Foreign Equity
EL Dynamic American Fund Select
1047 1147 1447 3247
EL Dynamic Global Discovery Fund Select
1045 1145 1445 3245
EL Mackenzie Global Small Cap Growth Fund Select
1017 1117 1417 3217
EL Invesco Europlus Fund Select
1018 1118 1418 3218
EL Invesco Global Companies Fund Select
1050 1150 1450 3250
EL Invesco International Companies Fund Select
1030 1130 1430 3230
Portfolio funds
EL Active Balanced Growth Portfolio Select
1039 1139 1439 3239
EL Active Balanced Income Portfolio Select
1038 1138 1438 3238
EL Active Balanced Portfolio Select
1037 1137 1437 3237
EL Invesco Intactive Balanced Growth Portfolio Select
1044 1144 1444 3244
EL Invesco Intactive Balanced Income Portfolio Select
1043 1143 1443 3243
EL Quotential Balanced Growth Portfolio Select
1022 1122 1422 3222
EL Quotential Balanced Income Portfolio Select
1021 1121 1421 3221
EL Quotential Diversified Equity Portfolio Select
1024 1124 1424 3224
EL Quotential Diversified Income Portfolio Select
1023 1123 1423 3223
EL Quotential Growth Portfolio Select
1025 1125 1425 3225
Based on our administrative rules, DSC, LL and NL-CB units may not be held within the same contract
EL = Equitable Life DSC = Deferred Sales Charge (Sales charge applies to client) NL = No Load LL = Low Load (Sales charge applies to client)
NL-CB = No Load CB (Chargeback to advisor)
Switch from fund name Fund code
Amount
£
% or
£
$
Switch to fund name Fund code
Amount
£
% or
£
$
693SEL(2020/02/24) Page 5 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
INVESTMENT DIRECTION – PIVOTAL SELECT
Select frequency: £ weekly £ monthly £ bi-monthly
£ quarterly £ semi-annually £ annually (yyyy/mm/dd) (yyyy/mm/dd)
From Fund To Fund(s)
Fund Code Amount Fund Code Amount
$
$
$
$
$
Each “from fund” minimum is $500 and each “to fund” minimum is $50. Dollar cost averaging must be within the same sales
charge option. Please refer to Section 4 for fund selection and fund codes.
4. Dollar cost averaging
6. Reset of death and maturity benefit guarantee
Resets are only available for Pivotal Select Estate Class (75/100) and Pivotal Select Protection Class (100/100) guarantee
options. Please refer to your information folder for explanation of terms and benefits.
Maturity Benefit Guarantee Reset
£ I/We authorize a reset of the maturity guarantee base on the above mentioned policy, and understand the following
reset provisions:
The reset date will be the date this direction form is received at our head office.
Exercising this reset will increase the maturity guarantee base to the contract value on the reset date. A reset will only occur if
the contract value is greater than the maturity guarantee base.
If the deposit maturity date is less than 15 years from the reset date, exercising this reset will also update the deposit maturity
date to 15 years from the reset date.
Death Benefit Guarantee Reset
£ I/We authorize a reset of the death benefit base on the above mentioned policy, and understand the following reset provisions:
The reset date will be the date this direction form is received at our head office.
Exercising this reset will increase the death benefit base to the contract value on the reset date. A reset will only occur if the
contract value is greater than the death benefit base.
From Fund To Fund(s)
Fund Code Amount Fund Code Amount
$
$
$
$
$
5. Switches
Please note: Fund switches must be within the same sales charge option. To make a transfer from DSC option or LL option to the NL option,
please use Change of Sales Charge Option (form #1388). Fund minimums must be maintained at all times.
A $25 fee may apply for withdrawals and switches. Switches do not affect your guarantees.
Indicate start date (1-28) : End date (Optional) (1-28) :
693SEL(2020/02/24) Page 6 of 6
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
INVESTMENT DIRECTION – PIVOTAL SELECT
9. Agreement & signatures
The undersigned has/have received and agree with all information and instructions set out above and also agree that:
Premium allocations and automatic investment options selected remain in effect until the company receives a written request for
change from the policyowner(s).
Premium allocations, transfers and automatic investment options are subject to the minimums stated in your policy contract.
Instructions for deposits will override any previous direction or automatic investment.
A transfer from another product may result in sales charges and/or loss of benefits, such as guarantees.
The personal information you willingly provided on this investment direction form will be used by us for the purposes of
underwriting, servicing and claims processing and adjudication in relation to this application and any resulting policy and any
subsequent documents. The information on file is accessible for the above purposes to our authorized employees and
reinsurer(s) as well as third parties retained by us and any other person or party whom the undersigned authorizes.
Date (yyyy/mm/dd) Policy owner’s signature:
Joint policy owner’s signature: Irrevocable beneficiary signature:
Assignee signature: Advisor’s signature (if limited trading authorization is on file):
(if applicable)
(if applicable)
(if applicable)
Send the completed form to:
Equitable Life of Canada
One Westmount Road North
P.O. Box 1603, Stn Waterloo
Waterloo, Ontario N2J 4C7
Fax: 519.883.7404
Email: Savingsretirement@equitable.ca
8. Special instructions
7. Source of funds
Check all that apply:
Salary or earned income
Borrowed funds
Applicant/owner savings
Business income
Gifted funds
Other
Sale of property
Proceeds from death benefits or estate
Note: Is a third party contributing the funds? £ No £ Yes please complete Third Party Form” (form # 31)
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