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iA Clarington Investments Inc. (iA Clarington)

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iA Clarington Investments Inc.
Mutual Fund investment application form
Please remember to:
1. Select your funds and fill in the amount to be invested.
2. Include your SIN number in section 4.
3. Sign the investment application in section 10.
4. Attach a void cheque or direct deposit form for section 8,
if completed.
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 Mutual Fund Investment
Application to open one of the
following:
• Non-registered (Cash/Open
account)
• Retirement Savings Plan (RRSP)
• Recognised Overseas Pension
Scheme (QROPS/ROPS)
• Retirement Income Fund (RRIF)
• 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. Investment Application Form | October 2019 3
1. REGISTRATION INFORMATION
MANDATORY
❑
New account ❑ Existing account # ❑ Transfer from existing IAC account #
2. PLAN TYPE
MANDATORY
❑Non-Registered Plan - Individual
Registered retirement savings plan (RRSP)
❑Individual ❑ Spousal ❑ QROPS/ROPS*
❑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
Registered retirement income fund (RRIF)
❑Individual ❑ Spousal
❑Non-Registered Plan - Formal Trust
Pension jurisdiction:
❑Non-Registered Plan - Corporate
*To subscribe to a Contract which qualifies as a Recognised Overseas Pension Schemes (QROPS/ROPS) you must be at least fifty-five (55) years of age.
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 accountholder 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
Address City Province Postal code
Residence phone number Business phone number Ext.
Client-held non-registered accounts only: If the plan holder/joint holder is considered a U.S. Resident or the corporation/formal trust is considered a U.S. entity, also attach a completed W-8BEN-E or W9 (IRS form).
B. Secondary accountholder 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 individual
**In Trust For designations are irrevocable
5. BENEFICIARY DESIGNATION
OPTIONAL – This section is not applicable for Quebec residents.
Primary beneficiary – this section is applicable to all Registered Plans. For residents of Quebec, beneficiary will be defaulted to the estate.
I revoke any previous designation of a beneficiary under my Registered Plan, and designate the person named below as the beneficiary under my Plan provided this person is living on the
date of the primary owner’s death; otherwise, payment will be made to the estate of the primary owner if no contingent beneficiary has been designated. The primary owner reserves
the right to revoke the beneficiary.
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 %
%
Primary beneficiary’s full name Date of birth (DD/MM/YYYY) Social insurance number Relationship to primary owner Shares %
%
Primary beneficiary’s full name Date of birth (DD/MM/YYYY) Social insurance number Relationship to primary owner Shares %
%
Check here
❑ if you have attached a separate sheet with additional primary or contingent beneficiary designations.
MUTUAL FUND INVESTMENT APPLICATION
Date of birth (DD/MM/YYYY)
Social insurance number/ Business ID number
MANDATORY
Date of birth (DD/MM/YYYY)
Social insurance numberr
MANDATORY
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. Investment Application Form | October 2019 4
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.
Distribution option
If no option is selected, IA Clarington Investments Inc. will reinvest
your distributions.
Void cheque required for EFT option
%
❑ EFT ❑ Mail cheque ❑ Redirect to fund #
%
❑ EFT ❑ Mail cheque ❑ Redirect to fund #
%
❑ EFT ❑ Mail cheque ❑ Redirect to fund #
%
❑ EFT ❑ Mail cheque ❑ Redirect to fund #
%
❑ EFT ❑ Mail cheque ❑ Redirect to fund #
Total: 100%
*For registered plans, distributions can only be re-invested or
re- directed to another fund.
Check here ❑ if you have attached a separate sheet with additional investment instruction and/or distribution instructions.
7. SYSTEMATIC PLANS
OPTIONAL VOID CHEQUE REQUIRED
A. PAC – Pre-authorized contribution plan (only applicable for non-registered and RSPs)
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.
B. SWP – Systematic withdrawal plan (only applicable for non-registered accounts)
C. SSP – Systematic switch plan: for automatic switches between funds in your account
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.
iii. PAC allocation
Fund code Amount
Total: $
❑ % ❑ $
Sales charge
front-end* (0-5%)
Must = 100% of amount *FE = 0% unless stated otherwise
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.
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
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.
iii. SSP instructions
From fund code To fund code SSP amount
Total: $
Dollar amounts only
(DD/MM/YYYY)
(DD/MM/YYYY)
(DD/MM/YYYY)
White copy to IA Clarington Investments Inc. Blue copy to dealer. Carbon white copy to client. Investment Application Form | October 2019 5
8. BANKING INFORMATION
MANDATORY
if section 6 (one time PAC or EFT distribution), 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 plan types.
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.
v. Successor annuitant
I hereby elect that my spouse, named below, become the annuitant under my RIF/LIF/LRIF/RLIF/PRIF in the event of my death, if he or she survives me. If my spouse becomes the annuitant,
my RIF/LIF/LRIF/RLIF/PRIF shall remain in force and no death benefit shall be payable until the death of my spouse. I understand that a contingent successor annuitant cannot be designated.
Successor annuitant’s (spouse) full name Date of birth (DD/MM/YYYY) Social insurance number
10. ACKNOWLEDGEMENT & AUTHORIZATION
MANDATORY for completion by all account owners.
A. Primary/joint account owner's acknowledgement
The undersigned hereby applies to IA Clarington Investments Inc. to purchase or redeem units of the Fund(s) as indicated and register the units in the name and address shown. I acknowledge receipt of the
current simplified prospectus and financial reports of the Fund(s) purchased and understand that these transactions are made under the terms and conditions therein. IA Clarington Investments Inc. may reject
a purchase application within one business day of receipt. I have requested that this document be drawn in the English language. J’ai exigé que ce document soit rédigé en anglais.
To: Industrial Alliance Trust Inc. (the “Trustee”) for a Registered Plan
I hereby apply for an IA Clarington Investments Inc. Retirement Savings Plan or IA Clarington Investments Inc. Retirement Income Fund (the “plan”) as indicated on Section 2 and request that you apply
for registration of the plan under the Income Tax Act (Canada). I agree to the terms and conditions of the declaration on the back of this application including any applicable locking-in addendum. I hereby
declare and acknowledge that:
1. I have read and agree to comply with the “Declaration of Trust” governing the plan set forth on the reverse and forming a part of this application and any applicable locking-in addendum;
2. I am aware that benefits paid out under the plan may be included in my income under the Income Tax Act (Canada) and under any applicable provincial tax legislation;
3. The assets of the plan are not insured under the Canada Deposit Insurance Corporation Act;
4. The Information contained in this plan application is complete and true in all respects;
5. I have received the Addendum according to my locked-in plan legislation.
X X
Signature of primary account owner Date (DD/MM/YYYY) Signature of joint owner (if applicable) Date (DD/MM/YYYY)
B. Primary owner’s spousal consent – Mandatory for LIF accounts under ON, NS, and NL pension jurisdiction
This annuitant’s spouse’s consent is required in order to open a LIF account governed under Ontario, Nova Scotia, and Newfoundland pension jurisdiction if the funds being transferred into
this account are originating from a LIRA, LRSP or RPP. I am the spouse of the annuitant named in section 4A of this application and I consent to the purchase of this locked-in income plan.
X
Full name of primary owner’s spouse (if applicable) Signature of primary owner’s spouse (if applicable) Date (DD/MM/YYYY)
C. Accepted by IA Clarington Investments Inc., as agent for Industrial Alliance Trust Inc., the Trustee.
X
Nov. 30, 2017
IA Clarington authorized signature Date
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)
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)
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Investment Application Form | October 2019 6
PRIVACY NOTICE
At IA Clarington Investments Inc. (“IA Clarington”) we take the issue of privacy seriously. We are committed to providing investors with excellent service while respecting the privacy of
personal information. Each IA Clarington employee is responsible for ensuring the confidentiality of all personal information to which they have access.
Your Personal Information
Personal information is information that identifies an individual. It includes information such as age, marital status, social insurance number, home address and telephone number.
How do we use personal information?
Obtaining personal information allows us to:
• Establish the identity of investors;
• Ensure our records are accurate;
• Establish and administer accounts;
• Execute transactions;
• Maintain account holdings and transaction records;
• Verify information previously given;
• Provide investors and their investment advisors account information and statements;
• Provide investors with financial statements, tax receipts, transaction confirmations, proxy mailing and other information that may be required to service accounts;
• Provide customer service; and
• Meet legal and regulatory requirements.
How do we obtain personal information?
In order to ensure that your investment in an IA Clarington investment product is administered efficiently, we will collect personal information from you or from your dealer. We may collect
the information in various ways, including electronic transfers and telephone calls, and may retain copies of documents, or recordings of telephone calls, that contain personal information.
To whom do we disclose personal information?
In order to provide the best possible client service, we may be required to disclose personal information to third parties in the normal course of business. These third parties include:
• Your investment advisor;
• Other financial institutions, securities dealers, and mutual fund companies; for example, when you move your investments from one firm to another;
• Affiliates of IA Clarington;
• Contracted third-party service providers;
• Canadian government, government agencies and regulators; and
• Any other entity as required by law.
IA Clarington may be required to provide personal information in response to a search warrant, court order or other legally valid request.
Obtaining Consent
If you have completed an investment application with us, you have provided us with personal information. Notice of IA Clarington’s use of personal information is disclosed on the back
of the IA Clarington investment application under the heading of “Your Personal Information”. By signing an application form you are consenting to the use of your personal information.
IA Clarington’s Privacy Notice explains how we collect, hold, use and disclose personal information. This Privacy Notice may also be sent to you. By continuing to do business with us,
you are consenting to the use of your personal information on an ongoing basis, as described under the heading “To whom do we disclose personal information?”
Some investors may have completed an investment application form through a dealer representative or other party that is unrelated to IA Clarington, thereby providing them with personal
information. Any personal information which may be disclosed to us through an unrelated party is also subject to IA Clarington’s Privacy Policy.
How can you withdraw your consent?
You may withdraw your consent to IA Clarington’s use of your information by contacting us. In some circumstances, legal requirements may prevent you from withholding consent. The
decision to withhold information may also limit the products or services we are able to provide.
How can you access your personal information?
Upon written request IA Clarington will provide you with access to the personal information we have collected for you. Please note that we may not be able to provide you with this
information in certain circumstances, for example: where information contains references to other persons; where information contains proprietary information confidential to IA Clarington,
or where information cannot be disclosed for legal reasons.
How can you ensure your information is accurate?
The accuracy of your personal information is essential to providing you with excellent service. If you wish to change or update your personal information, please contact us. Please inform
us of any errors regarding your personal information right away, so that we may correct our records.
Where is your personal information kept?
Your personal information may be kept in electronic or paper format in our offices, in secure off-site storage facilities, or in the offices of our service providers, such as International
Financial Data Services (Canada) Limited. Your personal information may also be held in the offices of U.S.-based third-party service providers that provide IA Clarington with data hosting
and imaging services, for example. U.S. laws regarding the protection of personal information may afford you lower protection than that of Canadian laws.
How do we protect your personal information?
Policies, procedures and safeguards have been put in place at IA Clarington to ensure your personal information is protected. Our employees and service providers have access to your
personal information to enable them to provide necessary services to you. Any personal information collected from you will only be used for the purposes identified at the time of collecting
the information and will be retained for as long as is necessary to fulfill the service, or as required by law.
Security measures including passwords, restricted access to our offices and records, and physical access security have been put in place to protect your information against unauthorized
access, modification, loss, theft or general misuse.
Questions, Concerns and Complaints
If you have any questions, concerns or complaints regarding matters of privacy please contact us. In many cases concerns can be resolved by discussing it with one of our Client Service
Representatives.
Phone: 1-800-530-0204 or 416-860-9880
Email: privacy@iaclarington.com
If your concern has not been resolved to your satisfaction, please contact our Privacy Officer.
Phone: 1-888-860-9888 or 416-860-9880
Email: privacy@iaclarington.com
Investment Application Form | October 2019 7
Write to: Privacy Officer
IA Clarington Investments Inc.
522 University Avenue, Suite 700 , Toronto, ON M5G 1Y7
If after contacting our Privacy Officer your concern remains unresolved, you may contact the Privacy Commission of Canada:
The Privacy Commission of Canada
112 Kent Street, Ottawa, Ontario K1A 1H3
Phone: 613-995-8210 or 1-800-282-1376
Or in Quebec:
La Commission d’accès à l’information du Québec
575, rue Saint-Amable, bureau 1-10, Québec (Québec) G1R 2G4
Phone: 418-528-7741 or 1-888-528-7741
PRE-AUTHORIZED DEBIT (PAD) AGREEMENT
Each account owner is referred to as “I” in this PAD Agreement section and makes the following statements in respect of himself or herself.
I authorize IA Clarington Investments 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, installments and charges arising from the contract
hereunder mentioned. Regular payments will be debited from my specified 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 PAD Agreement, all PADs from my account will be treated either as Personal or Business* depending on the choice I’ve made.
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 as I may have personally authorized.
I agree that the Company is not required to provide me with written notice of a change in a PAD amount that is made as a result of my request. If a PAD 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 PAD will be added to the subsequent PAD.
I may cancel or modify this PAD Agreement at any time, subject to providing the Company with thirty (30) days notice in writing. To obtain a sample cancellation form or for
more information on my right to cancel the PAD agreement, I may contact my financial institution or visit www.cdnpay.ca.
Any cancellation of this PAD 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 PAD Agreement without providing me with written notice of the assignment, any time prior to the next PAD.
I have certain recourse rights if any PAD does not comply with this PAD Agreement. For example, I have the right to receive reimbursement for any PAD that is not authorized or is not consistent
with this PAD agreement. To obtain more information on my recourse rights, I should contact my financial institution or visit www.cdnpay.ca.
*Business PAD means a PAD for the payment of goods or services related to a business or commercial activity of the payor.
SPECIFIC PAYMENT AGE PROVISION FOR ASSETS SOURCED FROM UK PENSION FUNDS
If you invest assets transferred from a UK pension plan into a registered savings plan RSP, also known as a QROPS/ROPS Recognised Overseas Pension Scheme you must be at least 55 years
of age. No transfers will be permitted prior to age 55 unless you are suffering from ill health and meet the requirements as detailed in the HMRC (Her Majesty’s Revenue and Customs)
Tax Manual. To obtain more information, you can visit www.gov.uk/hmrc-internal-manuals/pensions-tax-manual.
IA CLARINGTON INVESTMENTS INC. RETIREMENT SAVINGS PLAN – DECLARATION OF TRUST
Industrial Alliance Trust Inc. (the “Trustee”), is a trust company incorporated under the laws of Canada with its head office located at 1080 Grand Allée West, Quebec, Quebec G1K 7M3. You are the applicant
and annuitant as defined in the Income Tax Act (Canada) and named in the IA Clarington Investment Application (the “Application”) attached to this declaration. If you have selected an RSP, Locked-in RSP,
LIRA or RLSP as a type of account on your Application, the Trustee will act as trustee of a IA Clarington Investments Inc. Retirement Savings Plan (“your Plan”) for you on the following terms and conditions.
1. Acceptance and Registration: If the Trustee agrees to act as trustee of your Plan, the Trustee will apply to register your Plan under the Income Tax Act (Canada) (the “Tax Act”) as a registered
retirement savings plan (“RRSP”). You will be bound by the terms and conditions imposed on your Plan by all applicable legislation. If the Trustee declines to act as trustee, you or your agent will
be notified in writing and any amounts received by the Trustee as contributions will be returned to you or your agent.
2. Purpose: The Trustee will hold contributions accepted by it for your Plan, investments made with those contributions and any income and capital gains realized in respect of those investments
in trust for the purpose of providing you with a retirement income in accordance with the Tax Act.
3. Contributions to your Plan: You or, where applicable, your spouse may make contributions to your Plan from time to time in cash or securities which are acceptable to the Trustee in its sole discretion.
The Trustee will also accept contributions by way of a transfer to your Plan from any source permitted by the Tax Act. No contributions or transfers will be accepted after December 31 of the year in which
you reach the age specified in subparagraph 146(2)(b.4) of the Tax Act. The Trustee may accept or for any reason refuse to accept all or any portion of a contribution of cash or securities to your Plan.
4. Investments: Contributions to your Plan will be invested (and reinvested from time to time) in the investments selected by you in writing from time to time. In making your investment selection,
you may select units of mutual funds managed by IA Clarington Investments Inc. or other investments acceptable to the Trustee in its sole discretion. In making investments for your Plan, the Trustee
will not be limited to investments authorized by legislation governing the investment of property held in trust. All investments shall be qualified investments for registered retirement savings plans
within the meaning of the Tax Act and comply with the laws applicable to trusts subject to retirement savings plans. The Trustee will not provide any investment advice regarding the
purchase, retention or sale of any investment by your Plan and will not be held responsible for advice that you may have received from another party. Cash distributions received
on investments held in your Plan will be invested in additional investments of the same type unless you instruct otherwise. In the absence of satisfactory investment instructions, the Trustee will
invest cash in units of IA Clarington Money Market Fund.
5. Ownership and Voting Rights: The investments of your Plan will be held in the name of the Trustee or any other name the Trustee may determine. The Trustee is entitled to exercise in its sole
discretion, the rights, powers and privileges that could otherwise be exercised by the beneficial owner of the investments of your Plan.
6. Your Responsibility: You are responsible for (a) selecting investments for your Plan and assessing the merits of those investments or for obtaining investment advice; (b) ensuring that the investments
held in your Plan are qualified investments for your Plan under the Tax Act. The Trustee is not responsible for any of these matters or for any investment or tax advice that you may receive from your advisors.
7. Withdrawals and Refunds: Following the receipt of written instructions in a form acceptable to the Trustee, a payment or a reimbursement of premiums will be made from your Plan to: (a) you
or your spouse, as applicable, to reduce taxes otherwise payable under Part X.1 of the Tax Act on over-contributions to RRSPs; or (b) you. The Trustee is not responsible for determining the amount of
any payment made to reduce taxes otherwise payable under Part X.1 of the Tax Act. In the absence of satisfactory instructions, the Trustee may transfer or realize any investment of your Plan selected
by it, in its sole discretion, for the purpose of making the payment and will not be liable for any resulting loss. Payments will be made net of all proper charges including tax required to be withheld.
8. Transfers from your Plan: Following the receipt of your written instructions in a form acceptable to the Trustee, all or part of the assets of your Plan will be transferred (less all proper charges) to
the issuer of a registered pension plan, an RRSP or a registered retirement income fund (“RRIF”), as instructed by you in the notice. The Trustee will sell or transfer specific investments of your Plan to
effect the transfer if instructed by you in writing. In the absence of satisfactory written instructions, the Trustee may sell or transfer any investments of your Plan selected by it in its sole discretion to
effect the transfer and will not be liable for any resulting loss. The transfer of assets will be made subject to any restrictions under the Tax Act or the terms and conditions of the investments of your Plan.
9. Maturity: At any time before December 31 of the year in which you reach the age specified by the Tax Act, you may provide at least 90 days’ written notice to the Trustee instructing the Trustee to
Investment Application Form | October 2019 8
either: (a) liquidate the assets of your Plan and to use the proceeds (net of any applicable costs and charges) to acquire a life annuity selected by you from a company identified by you in the written notice;
or (b) transfer the assets of your Plan to a RRIF identified by you in the written notice. If the Trustee has not received your written instructions by October 31 of the year in which you reach the age specified
by the Tax Act, the Trustee will transfer the assets of your Plan to a IA Clarington Investments Inc. RRIF or another RRIF selected by the Trustee in its sole discretion. You hereby appoint the Trustee as your
attorney to execute documents and make elections necessary to establish the RRIF. However, if the issuer of the RRIF does not accept the transfer, the assets of your Plan will be paid or transferred to you.
10. Annuity: An annuity purchased with the assets of your Plan must conform to the requirements of the Tax Act which, among other things, requires the annuity to provide equal annual or more frequent periodic
payments to you, or to you until your death and then to your spouse, until there is a payment in full or partial commutation of the annuity and where the commutation is partial, equal annual or more frequent
periodic payments afterwards except for adjustments permitted by the Tax Act. Payments may not exceed a term of years equal to 90 minus either your age (in whole years) or, if your spouse is younger than you,
your spouse’s age (in whole years) at the time the annuity is purchased. Payments to your spouse in any year after your death may not be greater than payments made in a year before your death. If the annuity
becomes payable to a person other than you or your spouse, the value of payments must be commuted. Your Plan does not provide benefit payment after the maturity date of the Plan, except as retirement income
to the annuitant benefits to the annuitant, in full or partial commutation of retirement income under the Plan or as part of the conversion an annuity that would become payable to a person other than yourself.
11. Beneficiary Designation: 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, the Trustee prior to your death. Any designation, amended designation or revoked designation will be valid on the day following its receipt by the Trustee.
12. Death: Upon receipt of satisfactory evidence of your death, the Trustee will hold the assets of your Plan for payment in a lump sum to your designated beneficiary if that person was living on
the date of your death. If you have not designated a beneficiary or if your designated beneficiary predeceases you, the payment will be made to your legal representatives. The payment will be
made subject to the deduction of all proper charges, including income tax required to be withheld, after the Trustee receives the releases and other documents that it requires in its sole discretion.
13. Prohibition: No advantage that is conditional in any way on the existence of your Plan may be extended to you or a person with whom you do not deal at arm’s length. Retirement income under
your Plan can’t be assigned in whole or in part. The Trustee will not make any payments from your Plan except those specifically permitted under the provisions of this declaration or the Tax Act.
14. Date of Birth and Social Insurance Number: The statement of your and if applicable, your spouse’s birth date and social insurance number in the Application is deemed to be a certification
of its truth on which the Trustee may rely and your undertaking to provide proof if requested by the Trustee.
15. Your Account: The Trustee will maintain an account of your Plan recording: contributions to your Plan; the name, number and cost of investments purchased and sold by your Plan; distributions
received by your Plan; withdrawals, transfers and expenses paid from your Plan; and the balance of your account. The Trustee will send you a statement of your account at least once a year. Before April of
each year, the Trustee will provide you, or if applicable, your spouse with any contribution receipts pertaining to your Plan and required to be filed with your personal income tax return for the previous year.
16. Fees and Expenses: From time to time, the Trustee may charge you or your Plan fees for its services and expenses. The Trustee is entitled to reimbursement for all disbursements, expenses
and liabilities (including taxes, interest, penalties, brokerage fees, custodial fees, investment advisory fees, administrative fees and similar expenses except for those taxes, interest and penalties
that the Trustee is liable for under the Income Tax Act (Canada) and that can’t be paid out of the property of the Plan) reasonably incurred by the Trustee in connection with your Plan. You hereby
authorize the Trustee to deduct its unpaid fees, disbursements and expenses from the assets of your Plan and for this purpose authorize the Trustee to realize sufficient assets of your Plan selected
in its sole discretion for payment and the Trustee will not be liable for any resulting loss. If your Plan becomes liable for tax, interest or penalties under the Tax Act or similar provincial legislation,
the Trustee will realize sufficient investments of your Plan, selected in its sole discretion, to pay the liability and the Trustee will not be liable for any resulting loss.
17. Delegation of Duties: Without detracting in any way from the responsibility of the Trustee, the Trustee may appoint agents including, but not limited to, IA Clarington Investments Inc., and
may delegate to its agents the performance of clerical, administrative and other duties under this declaration. The Trustee may employ or engage accountants, brokers, lawyers or others and may
rely on their advice and services. The Trustee will not be liable for the acts or omissions of any of its advisors or agents. The Trustee may pay to any advisor or agent all or part of the fees received
by it under the terms of this declaration. Notwithstanding any other provision in this declaration, the Trustee acknowledges that it is ultimately responsible for the administration of your Plan.
18. Liability of the Trustee: None of the Trustee, its officers, employees or agents will be liable for any loss suffered or for any taxes, interest or penalties imposed under the Tax Act (except for those
taxes, interest and penalties that the Trustee is liable for under the Income Tax Act (Canada) and that can’t be paid out of the property of the Plan) as a result of holding or dealing with the assets of
your Plan in accordance with instructions which it believes in good faith to have been given by you or dealing with the assets of your Plan in accordance with the provisions of this declaration. You,
your personal representatives and each beneficiary under your Plan will at all times indemnify and save harmless the Trustee and its agents from all taxes, assessments, expense, liability, claims and
demands arising out of the purchase, sale or retention of assets of your Plan or anything done in connection with your Plan, other than as the result of their gross negligence or wilful misconduct. The
Trustee will not be liable for any loss or penalty suffered as a result of any act done by it in reasonable reliance of your authority or the authority of your properly authorized agent or legal representatives.
19. Successor Trustee: The Trustee may resign and be discharged from all duties and liabilities under this declaration by giving you 30 days’ written notice. IA Clarington Investments Inc. is nominated
to appoint a successor trustee. Upon acceptance of the office of trustee of your Plan, the successor trustee will be trustee of your Plan for all purposes as if it had been the original declarant of your Plan.
20. Amendments: From time to time, the Trustee may amend this declaration with the approval of the Minister of National Revenue provided that the amendment does not disqualify your Plan
as an RRSP under the Tax Act. Any amendment to ensure that your Plan continues to comply with the Tax Act will be effective without notice provided that, in the Trustee’s sole opinion, such
amendment does not adversely affect your rights under your plan. Any other amendment will be effective not less than thirty (30) days after written notice has been provided to you.
21. Notice: Any notice required or permitted to be given to you by or on behalf of the Trustee will be sufficiently given if mailed, postage prepaid, to you at your address as reflected in the
Application or any subsequent address that you have provided to the Trustee in writing for that purpose. Notice will be deemed to have been received by you on the day of mailing.
22. Locked-in Plans: If “locked-in” assets are transferred to your Plan in accordance with applicable pension legislation, this declaration will include the additional provisions of the applicable LIRA
addendum to this declaration. In the event of any inconsistency between the terms of the applicable LIRA addendum and the terms of this declaration, the terms of the LIRA addendum will apply.
23. Applicable Laws: This declaration will be governed, construed and enforced in accordance with the laws of Ontario and Canada except that the word “spouse” as used in this declaration and
the Application refers to a person recognized as a spouse or common-law partner for the purposes of the Tax Act.
Specimen Plan: RSP575-005 Revised: May 20, 2015.
IA CLARINGTON INVESTMENTS INC. RETIREMENT INCOME FUND – DECLARATION OF TRUST
Industrial Alliance Trust Inc. (the “Trustee”), is a trust company incorporated under the laws of Canada with its head office located at 1080 Grand Allée West, Quebec, Quebec G1K 7M3. You are the
applicant and annuitant as defined under the Income Tax Act (Canada) and named in the IA Clarington Investment Application (the “Application”) attached to this declaration. If you have selected an RIF,
LIF or LRIF as a type of account on your Application, the Trustee will act as trustee of a IA Clarington Investments Inc. Retirement Income Fund (“your Plan”) for you on the following terms and conditions.
1. Acceptance and Registration: If the Trustee agrees to act as trustee of your Plan, the Trustee will apply to register your Plan under the Income Tax Act (Canada) (the “Tax Act”) as a registered
retirement income fund (“RRIF”). You will be bound by the terms and conditions imposed on your Plan by all applicable legislation. If the Trustee declines to act as trustee, you or your agent will be
notified in writing and any amounts received by the Trustee as contributions will be returned to you or your agent.
2. Purpose: The Trustee will hold transfers accepted by it for your Plan, investments made with those contributions and any income and capital gains realized in respect of those investments in
trust for the purpose of providing you with a retirement income in accordance with the Tax Act.
3. Transfers to your Plan: The Trustee will accept transfers of cash or securities (acceptable to the Trustee in its sole discretion) to your Plan from property specified in subparagraph 146.3(2)(f)
of the Tax Act. The Trustee may accept or for any reason refuse to accept all or any portion of a transfer of cash or securities to your Plan.
4. Investments: Property transferred to your Plan will be invested (and reinvested from time to time) in the investments selected by you in writing from time to time. In making your investment
selection, you may select units of mutual funds managed by IA Clarington Investments Inc. or other investments acceptable to the Trustee in its sole discretion. In making investments for your Plan,
the Trustee will not be limited to investments authorized by legislation governing the investment of property held in trust. All investments shall be qualified investments for registered retirement
income fund within the meaning of the Tax Act (hereinafter called "Qualified Investments") and comply with the laws applicable to trusts subject to retirement income funds. The Trustee will not
provide any investment advice regarding the purchase, retention or sale of any investment by your Plan and will not be held responsible for advice that you may have received
from another party. Cash distributions received on investments held in your Plan will be invested in additional investments of the same type unless you instruct otherwise. In the absence of
satisfactory investment instructions, the Trustee will invest cash in units of IA Clarington Money Market Fund.
Investment Application Form | October 2019 9
5. Ownership and Voting Rights: The investments of your Plan will be held in the name of the Trustee or any other name the Trustee may determine. The Trustee is entitled to exercise in its sole
discretion, the rights, powers and privileges that could otherwise be exercised by the beneficial owner of the investments of your Plan.
6. Your Responsibility: You are responsible for (a) selecting investments for your Plan and assessing the merits of those investments or for obtaining investment advice; (b) ensuring that transfers
to your Plan are permitted by the Tax Act; (c) ensuring that the investments held in your Plan are Qualified Investments for your Plan under the Tax Act and (d) ensuring that any annuity purchased
with assets of your Plan complies with the Tax Act. The Trustee is not responsible for any investment or tax advice that you may receive from your advisors.
7. Retirement Income: The assets of your Plan will be used to provide you with an income that will begin on or before December 31 of the second calendar year of your Plan. In each calendar year,
the total amount of payments to you from your Plan may not be less than the minimum amount (the “Minimum Amount”) required to be paid under the Tax Act. The amount of any payment from your
Plan may not exceed the value of the property of your Plan immediately before the time of the payment. You may specify in writing in a form satisfactory to the Trustee, the amount and frequency
of the payments to be made during any year. The amount of payments may vary from year to year. You may change the amount and frequency of the payments or request additional payments by
instructing the Trustee in writing in a form satisfactory to the Trustee. If you do not specify the amount and frequency of payments to be made in a year or the amount that you specify is less than
the Minimum Amount for a year, the Trustee will make a payment or payments as it deems necessary, in its sole discretion, to ensure that the Minimum Amount for that year is paid to you. In the
absence of satisfactory instructions, the Trustee may transfer or realize any investment of your Plan selected by it, in its sole discretion, for the purpose of making a payment to you and will not be
liable for any resulting loss. Payments will be made net of all proper charges including tax required to be withheld. The Trustee may impose any other reasonable requirements and conditions in
respect of the foregoing. A payment to you will be deemed to have been made when: (a) a cheque payable to you is mailed in a postage pre-paid envelope addressed to you at the address indicated
on the Application or subsequently provided by you to the Trustee in writing; or (b) an amount is electronically transferred to the credit of a bank account designated by you in writing. The Trustee
can not make other payments than those provided for in paragraphs 146.3 (2) (d), 146.3 (2) (e) and 146.3 (14) of the Tax Act and retirement income according to paragraph 146.3 (2) (a) of the Tax Act.
8. Calculation of the Minimum Amount: The Minimum Amount will be zero in the first calendar year of your Plan and for each subsequent year will be calculated according to the provisions of
the Tax Act. You may elect to base the Minimum Amount on your age or your spouse’s age. This election is binding and cannot be changed, revoked or amended under any circumstances.
9. Transfers from your Plan: Following the receipt of your written instructions in a form acceptable to the Trustee, all or part of the assets of your Plan will be transferred (less all proper charges and
any amount that the Trustee is required by the Tax Act to retain to ensure the payment of the Minimum Amount) to the issuer of an RRSP, RRIF or life annuity that conforms with the Tax Act, as instructed
by you in the notice. No assets of your Plan will be transferred to an RRSP after December 31 of the year you reach age 71 (or another age specified by the Tax Act). The Trustee will provide the issuer
of the recipient plan with all relevant information in its possession. The Trustee will sell or transfer specific investments of your Plan to effect the transfer if instructed by you in writing. In the absence
of satisfactory written instructions, the Trustee may sell or transfer any investments of your Plan selected by it in its sole discretion to effect the transfer and will not be liable for any resulting loss. The
transfer of assets will be made subject to any restrictions according to the paragraphs 146.3 (2) (e), 146.3 (2) (e.1) and 146.3 (2) (e.2) of the Tax Act or the terms and conditions of the investments of your Plan.
10. Beneficiary Designation: 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) your spouse as successor
annuitant of your Plan; or (b) a beneficiary to receive the proceeds of your Plan in the event of your death. You may make, change or revoke your designation by written notice signed by you in a
form acceptable to, and received by, the Trustee prior to your death. Any designation, amended designation or revoked designation will be valid on the day following its receipt by the Trustee.
11. Death: Upon receipt of satisfactory evidence of your death, the Trustee will continue payments to your spouse provided he or she is the successor annuitant of your Plan. If your spouse becomes
the successor annuitant of your Plan, he or she will be deemed to be the annuitant of your Plan with the same rights as if he or she had been the original annuitant. If your spouse is not the successor
annuitant, the Trustee will hold the assets of your Plan for payment in a lump sum to your designated beneficiary if that person was living on the date of your death. If you have not designated a
beneficiary or if your designated beneficiary predeceases you, the payment will be made to your legal representatives. The payment will be made subject to the deduction of all proper charges,
including income tax required to be withheld, after the Trustee receives the releases and other documents that it requires in its sole discretion.
12. Prohibition: No benefit or loan that is conditional in any way on the existence of your Plan may be extended to you or a person with whom you do not deal at arm’s length. Payments under
your Plan may not be assigned in whole or in part. The Trustee will not make any payments from your Plan except those specifically permitted under the provisions of this declaration or the Tax Act.
13. Date of Birth and Social Insurance Number: The statement of your and if applicable, your spouse’s birth date and social insurance number in the Application is deemed to be a certification
of its truth on which the Trustee may rely and your undertaking to provide proof if requested by the Trustee.
14. Your Account: The Trustee will maintain an account of your Plan recording: all transfers to your Plan; the name, number and cost of investments purchased and sold by your Plan; distributions
received by your Plan; withdrawals, transfers and expenses paid from your Plan; the balance of your account; and the maximum and minimum amounts that may be paid from your Plan. The Trustee
will send you a statement of your account at least once a year. Before April of each year, the Trustee will provide you with any applicable income tax statement pertaining to your Plan and required
to be filed with your personal income tax return for the previous year.
15. Fees and Expenses: From time to time, the Trustee may charge you or your Plan fees for its services and expenses. The Trustee is entitled to reimbursement for all disbursements, expenses
and liabilities (including taxes, interest, penalties, brokerage fees, custodial fees, investment advisory fees, administrative fees and similar expenses except for those taxes, interest and penalties
that the Trustee is liable for under the Tax Act) reasonably incurred by the Trustee in connection with your Plan. You hereby authorize the Trustee to deduct its unpaid fees, disbursements and
expenses from the assets of your Plan and for this purpose authorize the Trustee to realize sufficient assets of your Plan selected in its sole discretion for payment and the Trustee will not be liable
for any resulting loss. If your Plan becomes liable for tax, interest or penalties under the Tax Act or similar provincial legislation, the Trustee will realize sufficient investments of your Plan, selected
in its sole discretion, to pay the liability and the Trustee will not be liable for any resulting loss.
16. Delegation of Duties: Without detracting in any way from the responsibility of the Trustee, the Trustee may appoint agents including, but not limited to, IA Clarington Investments Inc., and
may delegate to its agents the performance of clerical, administrative and other duties under this declaration. The Trustee may employ or engage accountants, brokers, lawyers or others and may
rely on their advice and services. The Trustee will not be liable for the acts or omissions of any of its advisors or agents. The Trustee may pay to any advisor or agent all or part of the fees received
by it under the terms of this declaration. Notwithstanding any other provision in this declaration, the Trustee acknowledges that it is ultimately responsible for the administration of your Plan.
17. Liability of the Trustee: None of the Trustee, its officers, employees or agents will be liable for any loss suffered or for any taxes, interest or penalties imposed under the Tax Act, except for
those taxes, interest and penalties that the Trustee is liable for under the Tax Act, as a result of holding or dealing with the assets of your Plan in accordance with instructions which it believes in
good faith to have been given by you or dealing with the assets of your Plan in accordance with the provisions of this declaration. You, your personal representatives and each beneficiary under
your Plan will at all times indemnify and save harmless the Trustee and its agents from all taxes, assessments, expense, liability, claims and demands arising out of the purchase, sale or retention
of assets of your Plan or anything done in connection with your Plan, other than as the result of their gross negligence or wilful misconduct. The Trustee will not be liable for any loss or penalty
suffered as a result of any act done by it in reasonable reliance of your authority or the authority of your properly authorized agent or legal representatives.
18. Successor Trustee: The Trustee may resign and be discharged from all duties and liabilities under this declaration by giving you 30 days’ written notice. IA Clarington Investments Inc. is nominated
to appoint a successor trustee. Upon acceptance of the office of trustee of your Plan, the successor trustee will be trustee of your Plan for all purposes as if it had been the original declarant of your Plan.
19. Amendments: From time to time, the Trustee may amend this declaration with the approval of the Minister of National Revenue provided that the amendment does not disqualify your Plan
as an RRIF under the Tax Act. Any amendment to ensure that your Plan continues to comply with the Tax Act will be effective without notice provided that, in the Trustee’s sole opinion, such
amendment does not affect your rights under your plan. Any other amendment will be effective not less than thirty (30) days after written notice has been provided to you.
20. Notice: Any notice required or permitted to be given to you by or on behalf of the Trustee will be sufficiently given if mailed, postage prepaid, to you at your address as reflected in the
Application or any subsequent address that you have provided to the Trustee in writing for that purpose. Notice will be deemed to have been received by you on the day of mailing.
21. Locked-in Plans: If “locked-in” assets are transferred to your Plan in accordance with applicable pension legislation, this declaration will include the additional provisions contained in the
applicable locking-in addenda to this declaration. In the event of any inconsistency between the terms of the applicable locking-in addenda and the terms of this declaration, the terms of the
applicable locking-in addenda will apply.
22. Applicable Laws: This declaration will be governed, construed and enforced in accordance with the laws of Ontario and Canada except that the word “spouse” as used in this declaration
and the Application refers to a person recognized as a spouse or common-law partner for the purposes of the Tax Act.
Specimen Plan: RIF 1392 Revised: May 20, 2015
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.
(19-1583) 10/19-010003-13
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