Fillable F51-153A-3 REQUEST FOR CHANGE WITH REGARD TO THE (iA Financial Group)

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F51-153A-3 REQUEST FOR CHANGE WITH REGARD TO THE (iA Financial Group)

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A
CHANGE OF ADDRESS
➜ Effective date
Y Y Y Y M M D D
No. Street Apt. PO Box
City Province Postal code
Email Telephone no.: Home Office
Area code Area code
B
CHANGE OF BENEFICIARIES
Complete section K - STATEMENT/SIGNATURES (mandatory).
(Notwithstanding any other Beneficiary designation, for a Contract held in the client’s name and if the Applicant acts as mandatary, trustee, tutor or guardian,
the Beneficiary of the Contract is the legal heir. However, if the Contract is held in a Registered Nominee or Intermediary Account, the Beneficiary of the
Contract is automatically the trustee of the Registered Nominee or Intermediary Account for the benefit of the holder of the Registered Nominee or
Intermediary Account. For a Contract held in a Nominee or Intermediary Account (Registered or Non-Registered), any death benefit will be paid to the Nominee
or Intermediary in trust for the Beneficiary or the estate.)
Notes: • Your spouse may be automatically entitled to benefits under a LIRA, a LIF or any other Locked-In Contract notwithstanding the Beneficiary designation.
• Quebec residents: if you name your spouse or civil union spouse as Beneficiary, the designation is considered irrevocable unless you check the box indicating that it is to be revocable.
First and last name Gender Date of birth % Type Relationship
M F
Y Y Y Y M M D D
Rev. Irrev.
M F Rev. Irrev.
M F Rev. Irrev.
Contingent Beneficiary The rights of a Contingent Beneficiary (Subrogated Beneficiary in Quebec) become in force only in the event that all primary beneficiaries have died before the Annuitant or if they have renounced to their
rights as primary beneficiaries. A Contingent Beneficiary (Subrogated Beneficiary in Quebec) remains revocable
).
First and last name Gender Date of birth %
M F
Y Y Y Y M M D D
Trustee for minor Beneficiary (Not applicable where Quebec laws apply):
Name of minor Beneficiary Date of birth Name of trustee Relationship to minor
Y Y Y Y M M D D
If a trustee is appointed above, any death benefit to be paid under the Contract to the minor Beneficiary who, at the time payment is to be made, is a minor, will be paid to the trustee, in trust
for the minor Beneficiary. The trust for any minor Beneficiary will terminate once the Beneficiary is a legal adult. Before completing the section above, please consult your legal advisor first.
C
APPLICANT/ANNUITANT/CO-APPLICANT (Non-registered plans only)
Complete section K - STATEMENT/SIGNATURES (mandatory).
Change of Applicant Change of Annuitant Change of Co-applicant Add Co-applicant
➜ This transaction will generated a new account including same conditions and provisions as the original account.
➜ Mandatory to complete and attach a new F51-208A for a new Applicant or Co-applicant or if the new Annuitant is also the Applicant.
➜ If the contract includes a CIDE benefit, it will be automatically withdrawn. If you wish to obtain one of these benefits for the new applicant, please complete the required form according to the contract.
➜ If the method of payment is pre-authorized debit (PAD), remember to make the applicable banking changes if necessary, using form F51-153A-1.
➜ In the absence of a new Beneficiary designation, the current designation will remain the same or if the new Annuitant is the current Beneficiary, then the default Beneficiary will be the Applicant or his/her estate.
➜ When changing or adding an Applicant, the new Applicant is bound by any in-force advisory fee agreement relating to the Contract.
Notes: 1. For all provinces and territories except Quebec: by designating a Co-Applicant, the Applicant and the Co-Applicant acknowledge and consent that the type of ownership is qualified as “joint ownership
WITH rights of survivorship”. Upon the death of the Applicant or the Co-Applicant who is not the Annuitant, his/her rights and obligations pursuant to the Contract pass automatically to the other.
2. For the province of Quebec only: by designating a Co-Applicant, the Applicant and the Co-Applicant acknowledge and agree that they respectively designate each other as Subrogated Applicant
of the Contract. Upon the death of the Applicant or the Co-Applicant who is not the Annuitant, they understand that the deceased’s rights and obligations pursuant to the Contract pass automatically
to the Subrogated Applicant.
First name Last name
Y Y Y Y M M D D
MANDATORY
Gender:
M
F
Relationship to the actual applicant Date of birth
SIN
Address:
No. Street Apt. PO Box
City Province Postal code
Email Telephone no.: Home Office
Area code Area code
{
to the applicant (residents of Quebec)
to the annuitant (residents outside
Quebec)
FundServ Contract
Dealer code Intermediary code
Annuitant’s first and last nameContract no.
Advisor
Agency code
S.U.
Advisor’s telephone number Extension
Advisor code
REQUEST FOR CHANGE WITH REGARD TO THE ANNUITANT/
APPLICANT/CO-APPLICANT/BENEFICIARY
INDIVIDUAL SAVINGS AND RETIREMENT
F51-153A-3
June 2020
F51-153A-3(20-06) PAGE 1 OF 2
iA Financial Group is a business name and trademark of
Industrial Alliance Insurance and Financial Services Inc.
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D
DESIGNATION OF A SUCCESSOR ANNUITANT
Complete section K - STATEMENT/SIGNATURES (mandatory).
Only for Ecoflextra contract and IAG Savings and Retirement Plan. For an IAG SRP contract opened between November 24, 2014,
and June 1, 2020, the rider F13-1054A must be provided by the Advisor to the Applicant for a new designation.
I hereby revoke any previous Successor Annuitant designation and designate the new Successor Annuitant for this contract.
• If a Successor Annuitant is designated, on the Annuitant’s death, the Contract remains in force and no death benefit is payable to the Beneficiaries or the estate.
• If the Annuitant is also the Applicant and a Successor Annuitant is designated, the Successor Annuitant shall become the Applicant on the Annuitant’s death,
unless there is a Co-Applicant or a Subrogated Applicant’s is designated.
• For a registered plan, only the spouse or common-law partner can be designated. Moreover, the designation is not applicable while this Contract is registered as
an RRSP/LIRA/LRSP and will only become applicable when it is converted into a RRIF/LIF. If the intention is to roll over to spouse at the RRSP/LIRA/LRSP stage,
you must designate him/her as the sole beneficiary of the Contract also.
First name Last name
Date of birth
Y Y Y Y M M D D
Relationship to the actual Annuitant (Must be the spouse or common-law partner for a registered plan): ________________________
I revoke any previous Successor Annuitant designated for this Contract.
E
ASSIGNMENT FOR COLLATERAL (Non-registered contracts and TFSA only)
Complete section K - STATEMENT/SIGNATURES (mandatory).
I hereby transfer and assign this contract to the assignee designated hereafter as collateral security for a debt.
Name of assignee
Address of assignee
No. Street Apt.
City Province Postal code
F
NAME CORRECTION
I would like to correct the name of the: annuitant applicant, according to the following instructions:
First name Last name
Due to: An error on the application Legal adoption Reinstatement of the maiden name A legal name change
An error when data was entered in the system
(Attach adoption papers.)
(Attach legal documents.)
G
CORRECTION TO THE DATE OF BIRTH
I would like to correct the date of birth of the: Annuitant Applicant Co-applicant
RESP beneficiary Subscriber, according to the following instructions:
Date of birth
Y Y Y Y M M D D
Due to: An error on the application (Attach proof of date of birth.) An error when the data was entered in the system
H
CHANGE IN REGISTRATION
(Between RRSP and non-registered Contracts only) ➜ Complete section K: Applicant’s signature mandatory
➜ In section J – SPECIAL INSTRUCTIONS indicate the investment products to be allocated to pay taxes.
Register or Deregister the following contract:
I
REQUEST TO CHANGE THE GUARANTEE MATURITY DATE
Complete section K - STATEMENT/SIGNATURES (mandatory).
If the annuitant is age 60 or over, the maturity date must be at least 10 years from the date of the request for an Ecoflex contract.
Guarantee 6 New maturity date
Y Y Y Y M M D D
Guarantee 5 New maturity date
Y Y Y Y M M D D
not allowed in the ten years period before maturity date.
If the annuitant is age 56 or older, the maturity date must be 15 years from the date that the request for the Ecoflex 100/100 series of the IAG Savings and Retirement Plan.
Ecoflex 100/100 Series New maturity date
Y Y Y Y M M D D
J
SPECIAL INSTRUCTIONS
K
STATEMENT/SIGNATURES
➜ Signature date
Y Y Y Y M M D D
• I request that the changes indicated be made in accordance with the rights, conditions and stipulations of the Contract or Participant.
• If Fund Units are credited to this contract for the first time or to the new participant:
I confirm that I have completed electronic investor profile no.
(to be included) or paper profile (to be included) with my
advisor and I acknowledge receipt of the Information Folder which describes the characteristics of my contract and the Fund Facts booklet.
_________________________________________________________________________ _____________________________________________________________
Applicant (before change) New Applicant
_________________________________________________________________________ _____________________________________________________________
Co-applicant (before change) Co-applicant (after change)
_________________________________________________________________________ _____________________________________________________________
Irrevocable beneficiary (before change) Irrevocable beneficiary (after change)
_________________________________________________________________________ _____________________________________________________________
Assignee Advisor/witness
Total Partial amount $ ______________
(N.B. For a Nominee/Intermediary Account, you must use the “Internal Transfer” form.)
(Transfers are made in kind and all conditions of the original Contract will continue to be applied.)
June 2020
F51-153A-3(20-06) PAGE 2 OF 2
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F51-153A-3 REQUEST FOR CHANGE WITH REGARD TO THE (iA Financial Group)

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Completed 26 October 2021

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