HOUSEHOLDING REQUEST FORM
2. General
i) Calculations for purposes of determining the management fee rates will be applied upon receipt of this Form,
in good order, by iA Clarington. Any modifications to the Eligible Accounts (i.e. removing or adding accounts/
members) will aect the management fee rates that are to be applied.
ii) Each investor is responsible for any modifications, cancellations or additions of Eligible Accounts. iA Clarington
cannot automatically link Eligible Accounts without authorization to do so. It is the responsibility of the investor
to ensure that the Form is completed correctly and all accounts meet the definition of “Eligible Accounts”. Any
errors in submissions are the responsibility of the investor. iA Clarington has the authority to retroactively charge
the client the correct management fee rates if errors in submissions are found.
iii) The linking of these Eligible Accounts may be terminated at any time by submitting an updated version of this
Form to iA Clarington.
iv) Any notice required or permitted under this Form shall be in writing and may be given to iA Clarington by delivery,
fax or mail as specified below. Any notice so transmitted shall be deemed to be given as of the date of transmission
or mailing.
v) The terms and conditions in this Form are in addition to all terms and conditions set forth in the applicable simplified
prospectuses, annual information forms, fund facts and other oering documents required by securities regulators
(collectively, the “Disclosure Documents”). If there is a conflict between this Form and a Disclosure Document,
the Disclosure Document prevails.
vi) Notice will NOT be sent to an investor who no longer qualifies for the management fee reduction.
vii) iA Clarington reserves the right to cancel or change Elite Pricing at any time at its discretion.
viii) If the linked Eligible Accounts no longer maintain at least one account with $250,000 invested in Eligible Holdings
or Series P securities, as applicable, we will de-link the accounts and the investments will no longer be eligible for
a management fee reduction.
Please contact us if you have any questions. Please return the completed form to:
IA Clarington Investments Inc.
30 Adelaide Street East, Suite 1
Toronto, Ontario M5C 3G9
Fax: 1-866-506-9884
Phone: 1-800-530-0204
3. Authorization
i) By signing below, I (we) certify that the accounts listed in section 1 satisfy the eligibility requirements for an
Eligible Account and are eligible for a management fee reduction.
ii) I (We) acknowledge and agree that calculations for purposes of determining the management fee rates will
be applied upon receipt of the Form, in good order, by iA Clarington. Any modifications made to the Eligible
Accounts, such as removing or adding accounts, may potentially aect the management fee rates that are
to be applied to each Eligible Account.
iii) For nominee accounts, the financial representative signing on behalf of the client represents that he or she
has the authority to sign on behalf of the client and agrees that iA Clarington may rely on this signature without
further inquiry.
iv) I (We) am (are) responsible for modifications, cancellations or additions of Eligible Accounts. iA Clarington
cannot automatically link any Eligible Accounts without authorization from the account holder of the Primary
Account and the new account holder being added to the list of Eligible Accounts.
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