F51-184A-1
August 2019
F51-184A-1(19-08) PDF PAGE 1 OF 4
A- DEPOSIT OF A SUBSEQUENT PREMIUM Complete section B – INVESTMENT INSTRUCTIONS
Client cheque: $_______________________ (Minimum $100)
Transfer from another company: $_______________________
(approximately)
Attach SDE0100 - Part A duly completed and signed, along with
TP.1029.8.Q if there is QESI present in the incoming transfer.
If the deposit is being made in a family plan, please indicate the allocation for each beneficiary:
(Minimum $10 per beneficiary):
Beneficiary:
__________________________________________________________________________________ ___________ %
Beneficiary: __________________________________________________________________________________ ___________ %
Beneficiary: __________________________________________________________________________________ ___________ %
B- INVESTMENT INSTRUCTIONS (MY EDUCATION/MY EDUCATION+ ONLY) Complete section D – STATEMENT/SIGNATURES
High Interest Savings Account: ___________________________________ % or $
Daily Interest Fund+ (DIF+): _______________________ % or $
If there is an AIT on the contract, the amounts deposited in the DIF+ will be invested according to the AIT when the required minimum has been reached.
Investment Funds: _______________________ % or $
Please refer to table F13-1000 for the investment fund numbers.
Investor profile is required if Premiums are invested in segregated
Funds for the first time.
** Minimum of $25 per fund and total must equal 100% of the
premium invested in the funds.
*** Contracts administered via FundSERV only.
Fund no.
If FEL, % of premiums
(My Education+ only)
% or $ **
Order no.***
Guaranteed Interest Fund (
!
My Education only): _______________________ % or $
Amount Type of interest Term
Simple
Compound (default)
1 month
_______years
C- CHANGE TO THE AUTOMATIC INVESTMENT TERM (AIT) (MY EDUCATION/MY EDUCATION+ ONLY) MES ÉTUDES
Modify the AIT for the Daily Interest Fund+ (DIF+):
Same instructions as in section B Cancel the existing AIT and leave the amounts in the DIF+
High Interest Savings Account: _______ % OR Guaranteed Investment funds (
!
My Education only)
Investment funds: ____________%
% %
% %
D- STATEMENT/SIGNATURES
I request that the transactions indicated be carried out in accordance
with the rights, conditions and stipulations of the contract.
Signature date:
Y Y Y Y M M M D D
If the contract is an RESP and the beneficiary will turn 16 before December 31st or if he/she is 16 or 17, I confirm that I have checked the CESG eligibility criteria before making
a deposit.
If Funds units are credited to this contract for the first time:
I confirm that I have completed electronic profile no.
(to be included) or a paper profile (to be included) with my advisor.
My Education contract opened before September 1, 2010: I acknowledge receipt of the Information Folder describing the characteristics of my contract and the
Fund Facts booklet.
My Education+ contract opened online at ia.ca: I acknowledge receipt of the My Education+ Contract, of the Information Folder in which the key characteristics of the
Contract are described, of the Fund Facts booklet and of the My Education+ Plan which replace the My Education+ Contract and the My Education+ Plan that I received
electronically.
X__________________________________________________________ X__________________________________________________________ X__________________________________________________________
Subscriber Joint subscriber Advisor/Witness
Transaction sent via FundSERV: Check here
SU
Subscriber first and last name (in block letters)
Agency code
Advisor code
Contract no.
Advisor
FundSERV contract
Dealer code Intermediary code
Advisor’s telephone number Extension
REQUEST FOR DEPOSIT AND MODIFICATIONS TO INVESTMENTS
REGISTERED EDUCATION SAVINGS PLAN (RESP)
INDIVIDUAL SAVINGS AND RETIREMENT
F51-184A-1(19-08)
Minimum amount Term Interest payment option
$500 (by default) or $1,000 Compound Simple
F51-184A-1
August 2019
F51-184A-1(19-08) PDF PAGE 2 OF 4
E- GUARANTEE INSTRUCTION
VERSION RESET CHANGE THE GUARANTEE MATURITY DATE (Complete section H – Declarations and Signatures)
My Education guarantee
16 and Diploma guarantees
13 and 19
Not allowed in the 10-year period
prior to the current guarantee
maturity date.
The maturity date of the fund guarantee must be at least ten (10) years from the date fund units
are purchased for the first time and must not exceed the termination date of the RESP plan.
Not allowed in the 10-year period prior to the current guarantee maturity date.
My Education, guarantee
17 and Diploma, guarantees
12 and 18
In the 10-year period prior to the
current guarantee maturity date,
the maturity date will be deferred
by 10 years from the request date
The maturity date of the fund guarantee must be at least ten (10) years from the date fund units
are purchased for the first time and must not exceed the termination date of the RESP plan.
New guarantee maturity date:
Y Y Y Y M M M D D
Ex.: 1990JAN27
F- INCREASE OR DECREASE IN PAD CONTRIBUTIONS Complete section I − Statement and Signatures for ALL Diploma and for all PAD increases.
I hereby request:
The DECREASE in my PAD contributions (Surrender fees apply to a PAD decrease for Diploma. The fee amount is calculated using the
following formula: 50% X amount of the decrease X number of PADs made (maximum 18).)
The INCREASE in my PAD contributions
(If your contract contains CIDE/CID coverage,
you must complete life insurance form F51-298A
to increase coverage.)
According to the following instructions: New TOTAL PAD amount
Individual plan (Minimum $25 by frequency): $_______________________
Family plan (My Education or My Education+) (Min. $10 per beneficiary and $25 per frequency) $_______________________
G- CHANGE THE BENEFICIARY ALLOCATION FOR FUTURE DEPOSITS – Family RESP only
Beneficiary name Total
% allocated
100%
H- SPECIAL INSTRUCTIONS
I- STATEMENT/SIGNATURES
I request that the transactions indicated be carried out in accordance
with the rights, conditions and stipulations of the contract.
Signature date:
Y Y Y Y M M M D D
If the contract is an RESP and the beneficiary will turn 16 before December 31st or if he/she is 16 or 17, I confirm that I have verified the CESG eligibility criteria before making
a deposit.
If Funds units are credited to this contract for the first time:
I confirm that I have completed electronic profile no.
(to be included) or a paper profile (to be included) with my advisor.
My Education contract opened before September 1, 2010: I acknowledge receipt of the Information Folder describing the characteristics of my contract and the
Fund Facts booklet.
My Education+ contract opened online at ia.ca: I acknowledge receipt of the My Education+ Contract, of the Information Folder in which the key characteristics
of the Contract are described, of the Fund Facts booklet and of the My Education+ Plan which replace the My Education+ Contract and the My Education+ Plan that
I received electronically.
X__________________________________________________________ X__________________________________________________________ X__________________________________________________________
Subscriber Joint subscriber Advisor/Witness
Contract no.
THE COMMITMENT ON A DIPLOMA CONTRACT MUST BE UP-TO-DATE
BEFORE THE AMOUNT OF THE PAD CONTRIBUTION IS INCREASED.
!
IMPORTANT
F51-184A-1
August 2019
F51-184A-1(19-08) PDF PAGE 3 OF 4
Contract no.
PRE-AUTHORIZED DEBIT (PAD) Turnaround time to activate or change a PAD:
AGREEMENT GENERAL INFORMATION three days following receipt at Service Centre.
IMPORTANT
If the bank account owner’s signature is required, you must provide him or her with the PRE-AUTHORIZED
DEBIT (PAD) AGREEMENT.
1. Indicate if it’s a:
Instructions
Signature See below if bank account owner’s or advisor’s
signature is required in point 6.
PAD enrolment − PAD amount: $__________________
Complete items 3 and 4. Signature of bank account owner mandatory
Make one-time PAD − amount: $__________________
Complete items 3 and 4. Signature of bank account owner mandatory
Change in banking information
With changes to the payor complete item 5
Signature of bank account owner mandatory
Without changes to the payor complete item 5
Signature of client or advisor with or without LTA
Change to regular PAD
(Frequency, PAD date, AIT)
Indicate changes to make in point 4. Signature of client or advisor with or without LTA
Change to PAD loan (Frequency, PAD date)
Indicate changes to make in point 4. Signature of client or advisor with or without LTA
PAD reactivation
Confirm the information in point 4, and if the
banking information needs to be changed,
see point 5.
If no change in banking information: Signature of client
or advisor with or without LTA
If change in banking information with change in payor:
Signature of bank account owner
Termination of PAD (for DIPLOMA, the PAD
will be suspended and fees may apply.)
Indicate: Immediate (Default) or
After PAD dated:
Y Y Y Y M M M D D
Ex.: 1990JAN27
My Education/My Education+ : Signature of client or
advisor with or without LTA
!
Diploma: Signature of client mandatory
2. Withdrawal Agreement: Variable
3. PAD category:
Personal Business (If both boxes are left unchecked, the PAD category will be deemed “Personal”.)
4.
PAD information:
REGULAR
PAD:
Frequency:
Monthly (Day 1 to 28) Last day of each month Weekly Every 2 weeks
Must be monthly for DIPLOMA PAD.
Date of first withdrawal or modification
Y Y Y Y M M M D D
Ex.: 1990JAN27
INVESTMENT
INSTRUCTIONS
FOR REGULAR
PADs AND ONE
-TIME PAD (AIT
PAD):
Minimum $25 per
investment fund,
whatever the
frequency
High Interest Savings Account: _____________%
Daily Interest Fund+ (DIF+): ____________%
Investment funds:
% %
% %
Guaranteed Interest fund (GIF)
!
My Education only
Minimum amount Terme Interest payment option
$500 (by default)
$1,000
Compound
Simple
*Investments in a GIF can only be made through an AIT in the DIF+.
5. BANKING INFORMATION (Attach a void personal cheque or a banking information sheet completed by your financial institution)
Transit number: Financial institution number: Account number:
Name of the account owner(s): __________________________________________________________________________________________________________________________________________________
6. PAD AGREEMENT AND SIGNATURES
By signing below, I, the bank account owner(s), confirm I have read, understand and agree to the information and provisions of the PAD Agreement in this form.
For a joint account, all required signatories must sign this PAD Agreement.
For a company, the PAD Agreement must be signed by an authorized signatory; attach a copy of the company’s resolution stipulating the authorized signatories.
!
____________________________ X _______________________________ X _______________________________ X _______________________________
Date Account owner’s signature Joint account owner’s signature Advisor/Witness
(as shown on bank records) (if required)
F51-184A-1
August 2019
F51-184A-1(19-08) PDF PAGE 4 OF 4
PRE-AUTHORIZED DEBIT (PAD) AGREEMENT
In this PAD Agreement, each owner is referred to as “I” and makes the following statements in respect to himself or herself:
I authorize Industrial Alliance Insurance and Financial Services Inc. (“iA Financial Group”) 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 one-time payments from time to time for payment of all premiums, deposits,
installments and charges arising from the contract mentioned herein;
Regular payments will be debited from the account that I have indicated on/at the date and/or frequency I have chosen, whereas one-time payments from time to time can be
debited from my account on any date. Regular and/or one-time payments will be debited in accordance with the banking information set out on the page 3;
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 have made hereinabove;
I waive the right to receive pre-notification of an increase or decrease in the amount to be debited or a change in the date and/or frequency of these payments;
I agree that iA Financial Group 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 dishonored for any reason such as, but not limited to, insufficient funds (“NSF”), stop payment or account closed, iA Financial Group is authorized to re-submit the
payment. Any charges incurred by iA Financial Group as a result of a dishonored PAD will be charged within the Contract as per last PAD investments;
I may cancel or modify this PAD Agreement at any time, subject to providing iA Financial Group 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.payments.ca regarding Rule H1-Pre-authorized
debits (PADs);
Any cancellation of this PAD agreement will not affect my insurance contract(s) and/or contract(s) for financial services, so long as payment is provided by an alternate method;
iA Financial Group will not assign this PAD Agreement without providing, any time prior to the next PAD, written notice to me of the assignment;
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.
payments.ca regarding Rule H1-Pre-authorized debits (PADs);
Before iA Financial Group debits the first PAD payment, it must receive all required documents, duly completed, and be allowed a reasonable period of time to complete its
administrative processes.
I confirm that all persons whose signature is required to authorize transactions within the account have signed hereinabove.
*Business PAD means a PAD for the payment of goods or services related to a business or commercial activity of the payor.
iA Financial Group is a business name and trademark of
Industrial Alliance Insurance and Financial Services Inc.
ia.ca
Telephone number: 1-844-4iA-INFO (1-844-442-4636) Information: savings@ia.ca
Quebec:
1080 Grande Allée West
PO Box 1907, Station Terminus
Quebec City, QC G1K 7M3
Fax: 418-684-5161
Transactions: IAQtransactions@ia.ca
Toronto:
522 University Avenue, Suite 400
Toronto, ON M5G 1Y7
Fax: 1-800-810-0197
Transactions: IATtransactions@
ia.ca
Vancouver:
988 West Broadway, Suite 400
PO Box 5900
Vancouver, BC V6B 5H6
Fax: 1-833-832-7474
Transactions: IAV-transactions@ia.ca