PRE-AUTHORIZED CHEQUING AGREEMENT
(Pre-Authorized Debit (PAD) Agreement)
(Not Applicable For Locked-In RSP, LIRA, RIF, LIF, LRIF, PRIF, RLIF, RLSP, or RDSP* Account Types)
*Please complete the RDSP Disability Assistance Payment and Pre-Authorized chequing form
• By signing this form, you (the bank account holder(s)) hereby waive any pre-notification requirements
as specified by sections 15(a) and (b) of the Canadian Payments Association Rule H1 with respect
to pre-authorized debits.
• You authorize Mackenzie Investments to debit the bank account provided for the amount(s) and
in the frequencies instructed.a
• If this is for your own personal investment, your debit will be considered a Personal Pre-authorized
Debit (PAD) by Canadian Payments Association definition. If this is for business purposes, it will be
considered a Business PAD. Monies transferred between CPA members will be considered a Funds
Transfer PAD.
• You have certain recourse rights if a debit does not comply with this agreement. For example, you
have the right to receive reimbursement for any debit that is not authorized or is not consistent
with this pre-authorized debit agreement. To obtain more information on your recourse rights, you
may contact your financial institution or visit
www.cdnpay.ca
.
• You confirm that all persons whose signatures are required to authorize transactions in the bank
account provided have signed this agreement.
• You may change these instructions or cancel this plan at any time, provided that Mackenzie Investments
receives at least 10 business days notice by phone or by mail. To obtain a copy of a cancellation
form or for more information regarding your right to cancel a pre-authorized debit agreement,
please consult with your financial institution or visit the Canadian Payments Association website
at
www.cdnpay.ca
. You agree to release the financial institution of all liability if the revocation is
not respected, except in the case of gross negligence by the financial institution.
• Mackenzie Investments is authorized to accept changes to this agreement from my registered dealer
or my financial advisor in accordance with the policies of that company, in accordance with the
disclosure and authorization requirements of the CPA.
• You agree that the information in this form will be shared with the financial institution, insofar as
the disclosure of this information is directly related to and necessary for the proper application of
the rules applicable for pre-authorized debits.
• You acknowledge and agree that you are fully liable for any charges incurred if the debits cannot
be made due to insufficient funds or any other reason for which you may be held accountable.
• You have requested this application form and all other documents relating hereto to be in English.
Vous avez exigé que ce formulaire et tous les documents y afférant soient rédigés en anglais.
*A completed application may be required.
Account Number
❏
New Account*
Account Number
❏
Existing Account
First Name Last Name
Joint Planholder (if applicable) First Name Joint Planholder (if applicable) Last Name
Bank Account Holder’s/Plan Holder’s Signature Date Advisor Name Dealer/Advisor Code
Joint Bank Account Holder’s/Plan Holder’s Signature Date Dealer Name
Plan Holder’s Signature (If Different From Bank Account Holder’s) Date Dealer Authorization/Advisor Signature Date
* RCS – Redemption charge purchase option (Back end load)
**
LL3 – Low-load 3 purchase option
†
LL2 – Low-load 2 purchase option
††
SCS – Sales charge option (Front end load)
FUND
NUMBER FUND NAME
AMOUNT
($ OR %)
*RCS
PURCHASE
OPTION (✔)
**LL3
PURCHASE
OPTION (✔)
†
LL2
PURCHASE
OPTION (✔)
††
SCS
SALES
CHARGE %
PRE-AUTHORIZED
CHEQUING PLAN
($ OR %)
TOTAL: $ $
To: __________________________________________ AND TO: Mackenzie Investments (Void Cheque Required)
❏
Please stop existing PACs
Undersigned’s Bank
Date
My first purchase
is to commence ____________________________
Protect my PAC deposits
against inflation by
an annual increment of ____________ %
DD MMM YYYY
DD MMM YYYY
DD MMM YYYY
DD MMM YYYY DD MMM YYYY
1
Once every 14 days
2
15th and end of month
3
Every other month
4
Every six months
Semi-Annually
4
Process my PAC
purchase:
Bi-Weekly
1
Semi-Monthly
2
Bi-Monthly
3
AnnuallyWeekly Monthly Quarterly
03212 11/16
1. PLAN INFORMATION
2. PLANHOLDER INFORMATION – PLEASE PRINT
3. FUND SELECTION
4. TERMS & CONDITIONS
5. AUTHORIZATION
