Postal Code:
Home Telephone:
Business Telephone:
E-mail:
Fax:
Date of Birth: [day] [month] [year]
Source of Funds: Registered: or..Non-Registered:
If Registered Funds: RRSP/RRIF:
or..Locked-in Pension:
Amount of funds available:
Type:
Single Life:
Joint Life:
Term Certain:
payments guaranteed for years.
SPOUSAL INFORMATION: Please complete the following only if you wish to have a joint annuity.
Spouse Full Name:
Gender: Male
Female
Date of Birth: [day] [month] [year]
Provide a life insurance quote for returning the cost of my annuity to my survivors in a lump sum tax free upon my death: Yes
No
Only answer the following questions about smoking habits if you are requesting a life insured annuity.
Ever use tobacco? yes no
If yes to tobacco use, when last used?
Ever use marijuana? yes no
If yes to marijuana use, when last used?
Comments/questions:
