How to complete the enclosed documents
Transcription
How to complete the enclosed documents
How to complete the enclosed documents How to complete the enclosed Investment Account Application If you need help completing this form, contact one of our Client Service Representatives at 1.800.387.2087 or speak with your advisor. Section 1 (Mandatory) Indicate the account type. If you have an individual investment loan, your account type will be individual. If you have a co-borrower, your account type will be either Joint Rights of Survivorship or Tenants in Common. You must also indicate the intended use of the account. For example, “investments”. If you wish to have your statements emailed to you, check the “I agree…” box. B2BBankFinancialServicesInc.("B2BBFSI") InvestmentAccountApplication 1. AccountType(Checkoneonly)andIntendedUse ✔ Individual a) r r Corporation b) r Joint Rights of Survivorship* (JTWROS; not available in Quebec) r Unincorporated Organization (ex. Association, Charity, Condo Board, Partnership, etc.) r Formal Trust c) r Tenants in Common* (TIC) •PleaseattachtheFormalTrustagreement(preparedbyclient'slegaladvisors) d) r In Trust For* (ITF – Informal trust; includes ITF accounts with co-applicants) •(Optional)Attachaseparatesheetwithtrustees’andbeneficiaries’addressesifdifferentfromSection2 e) r Estate: submit in Executor’s name “as executor for the estate of...” If any of a) - d) is checked, and it is also a Group account, check here r * Note: Attach a separate sheet for more than 2 applicants or ITF beneficiaries. Joint accounts are limited to 4 applicants. ITF accounts are limited to a combined total of 4 applicants and ITF beneficiaries. Investing WhatistheIntendedUseofAccount?(ie,RetirementSavings,Children’sEducation,etc.) Electronicdeliveryofclientcommunications(includingstatements,tradeconfirmations,andtaxdocuments)isfaster,convenientandenvironmentallyconscious.Bycheckingtheboxbelow,Iwishtoreceivemyclientcommunications ✔ I agree to the foregoing. electronically (where applicable) via the e-mail address provided below. Please send me the enrolment information for eDelivery and Investor Access. r 2. ApplicantInformation 999-999-999 BUSINESS/TRUST/OTHER ENTITY NUMBER (for tax reporting) SOCIAL INSURANCE NUMBER 1-Mr 2-Mrs Smith 1 3-Miss 4-Ms LAST NAME OR COMPANY / ORGANIZATION NAME 5-Dr. 6-Prof. 123 Any Street ADDRESS ( 555 ) 123-4567 Robert FIRST NAME APT. ( 555 ) 987-6543 RESIDENCE TELEPHONE NUMBER BUSINESS TELEPHONE NUMBER 0 APT. [email protected] E-MAIL ADDRESS ACME company Canada Canadian CITY POSTAL CODE CITIZENSHIP 15 Manufacturing Section 2 (Mandatory) EMPLOYER ADDRESS CITY Complete all information in section 2. NATURE OF PRINCIPAL BUSINESS OR OCCUPATION Are you: (i) an officer or director of a reporting issuer or any other issuer whose securities are publicly traded (e.g. and entity whose securities are traded on a stock exchange or an over-the-counter market) (an “Issuer”); or (ii) an officer or director of a person or company which is itself an ✔ NO r r YES insider or a subsidiary of such Issuer? 999 Main Street Toronto Human Resources Manager If yes, please list the Issuer(s): YEARS WITH EMPLOYER B3B 4C4 ON PROVINCE POSTAL CODE ✔ NO Are you designated as a Pro (licensed to sell securities)? r Doyou: (i) beneficiallyown;or (ii) have control or direction over; or (iii)haveacombinationofbeneficialownershipof,andcontrolordirectionover, directly or indirectly, securities of an Issuer carrying more than 10% of the voting ✔ NO r rights attached to all of the Issuer’s outstanding voting securities? r YES r YES If yes, please list the Issuer(s): Do you or as part of a group, hold or control an Issuer? r YES r YES ✔ NO r If yes, please list the Issuer(s): Pleaserefertothedefinitionof“Politicallyexposedforeignperson”(“PEFP”)andthedefinitionofprescribedfamilymember(“PrescribedFamilyMember”)includedonthisapplicationform. ✔ NO r Is the Applicant a PEFP or is the Applicant a PEFP because the Applicant is a Prescribed Family Member of a PEFP? If Yes, please complete and attach the supplemental form – Politically Exposed Foreign Person Statement. 3. Co-ApplicantInformation rCheckboxifseparatesheetattachedwithadditionalapplicants IstheCo-Applicantthespouse/commonlawpartneroftheApplicant? r NO r YES 1-Mr 2-Mrs 3-Miss 4-Ms 5-Dr. 6-Prof. LAST NAME SOCIAL INSURANCE NUMBER (YYYY Y Y Y Y/ M M/ /MM DD) DATE OF BIRTH FIRST NAME / DD INITIALS Address: rSameasApplicant,or ADDRESS ( ) RESIDENCE TELEPHONE NUMBER # OF DEPENDANTS ( ) APT. BUSINESS TELEPHONE NUMBER CITY PROVINCE POSTAL CODE COUNTRY* CITIZENSHIP * Any person who resides outside Canada is required to provide proof of citizenship E-MAIL ADDRESS EMPLOYER NAME TYPE OF BUSINESS EMPLOYER ADDRESS CITY PROVINCE POSTAL CODE Are you designated as a Pro (licensed to sell securities)? r NO Doyou: (i) beneficiallyown;or (ii) have control or direction over; or (iii)haveacombinationofbeneficialownershipof,andcontrolordirectionover, directly or indirectly, securities of an Issuer carrying more than 10% of the voting r NO rights attached to all of the Issuer’s outstanding voting securities? NATURE OF PRINCIPAL BUSINESS OR OCCUPATION Are you: (i) an officer or director of a reporting issuer or any other issuer whose securities are publicly traded (e.g. and entity whose securities are traded on a stock exchange or an over-the-counter market) (an “Issuer”); or (ii) an officer or director of a person or company which is itself an r NO r YES insider or a subsidiary of such Issuer? If yes, please list the Issuer(s): Do not complete this section. A1A 2B2 PROVINCE CITY PROVINCE POSTAL CODE * Any person who resides outside Canada is required to provide proof of citizenship ✔ English Language Preference r r French TYPE OF BUSINESS Section 4 (Not required) / 03 INITIALS ON EMPLOYER NAME Complete this section only if there is a co-applicant on this account, including if the co-applicant is your spouse. ( 1969 Y Y Y Y/ M M/ / D08 D) DATE OF BIRTH Toronto COUNTRY* MAILING ADDRESS IF DIFFERENT FROM ABOVE # OF DEPENDANTS Section 3 (Optional) FORINTERNALUSE YEARS WITH EMPLOYER If yes, please list the Issuer(s): Do you or as part of a group, hold or control an Issuer? r NO If yes, please list the Issuer(s): Pleaserefertothedefinitionof“Politicallyexposedforeignperson”(“PEFP”)andthedefinitionofprescribedfamilymember(“PrescribedFamilyMember”)includedonthisapplicationform. Is the Co-Applicant a PEFP or is the Co-Applicant a PEFP because the Co-Applicant is a Prescribed Family Member of a PEFP? r NO If Yes, please complete and attach the supplemental form – Politically Exposed Foreign Person Statement. r YES r YES r YES r YES 4. InTrustForInformation-namesbelowwillbeincludedinoneaccount •AttachaseparatesheetwithaddressesofITFindividuals(ie.beneficiaries),ifdifferentfromApplicant’saddress LAST NAME FIRST NAME LAST NAME FIRST NAME (YYYY Y Y Y Y/ M M/ /MM DD) DATE OF BIRTH (YYYY Y Y Y Y/ M M/ /MM DD) DATE OF BIRTH / DD / DD r Check box if separate sheet attached for additional ITF individuals, or if ITF individual addressisdifferentfromApplicant'saddress. 225-07-504E (01/01/2014) How to complete the enclosed Investment Account Application — Page 2 Section 5 (Optional) The spousal information for each of the applicants (if applicable) should be provided in this section. If your spouse is the co-applicant, leave this section blank (see section 3). 5. SpousalInformation Applicant’sInformation(CompleteifspouseisnotaCo-Applicant) Doyouhaveaspouse/commonlawpartner?Ifyes,completethissection 2 ✔ YES r ✔ SameasApplicant,or Address:r APT. COUNTRY CITY 1972 / 08 / 27 ( Y Y Y Y/ M M / D D ) PROVINCE Canadian CITIZENSHIP POSTAL CODE ADDRESS APT. COUNTRY CITY PROVINCE POSTAL CODE CITIZENSHIP YYYY / MM / DD 555-555-555 ( Y Y Y Y/ M M / D D ) SOCIAL INSURANCE NUMBER DATE OF BIRTH EMPLOYER’S NAME SOCIAL INSURANCE NUMBER EMPLOYER’S NAME 1010 Centre Street EMPLOYER’S ADDRESS 9 Financial Services TYPE OF BUSINESS YEARS WITH EMPLOYER Branch Manager Section 7 (Not required) FIRST NAME Address:r SameasCo-Applicant,or ANC Financial If you have an advisor, their information goes here. If not, leave it blank. Checkboxifseparatesheetattachedwithinformationonadditionalco-applicants. 1-Mr 2-Mrs 3-Miss 4-Ms 5-Dr. 6-Prof. LAST NAME FIRST NAME DATE OF BIRTH Section 6 (Optional) Co-Applicant’sInformation(CompleteifCo-ApplicantisnotApplicant’sspouse) Doyouhaveaspouse/commonlawpartner?Ifyes,completethissection r NO r YES r Jane Smith 1-Mr 2-Mrs 3-Miss 4-Ms 5-Dr. 6-Prof. LAST NAME ADDRESS r NO NATURE OF PRINCIPAL BUSINESS OR OCCUPATION ✔ NO r r YES Are you designated as a Pro (licensed to sell securities)? Are you: (i) an officer or director of a reporting issuer or any other issuer whose securities are publicly traded (e.g. and entity whose securities are traded on a stock exchange or an over-the-counter market) (an “Issuer”); or (ii) an officer or director of a person or company which is itself an ✔ NO r r YES insider or a subsidiary of such Issuer? If yes, please list the Issuer(s): Doyou: (i) beneficiallyown;or (ii) have control or direction over; or (iii) haveacombinationofbeneficialownershipof,andcontrolordirectionover, directly or indirectly, securities of an Issuer carrying more than 10% of the voting ✔ NO r r YES rights attached to all of the Issuer’s outstanding voting securities? If yes, please list the Issuer(s): ✔ NO Do you or as part of a group, hold or control an Issuer? r r YES If yes, please list the Issuer(s): EMPLOYER’S ADDRESS TYPE OF BUSINESS YEARS WITH EMPLOYER NATURE OF PRINCIPAL BUSINESS OR OCCUPATION r NO r YES Are you designated as a Pro (licensed to sell securities)? Are you: (i) an officer or director of a reporting issuer or any other issuer whose securities are publicly traded (e.g. and entity whose securities are traded on a stock exchange or an over-the-counter market) (an “Issuer”); or (ii) an officer or director of a person or company which is itself an r NO r YES insider or a subsidiary of such Issuer? If yes, please list the Issuer(s): Doyou: (i) beneficiallyown;or (ii) have control or direction over; or (iii) haveacombinationofbeneficialownershipof,andcontrolordirectionover, directly or indirectly, securities of an Issuer carrying more than 10% of the voting r NO r YES rights attached to all of the Issuer’s outstanding voting securities? If yes, please list the Issuer(s): Do you or as part of a group, hold or control an Issuer? r NO r YES If yes, please list the Issuer(s): 6. DealerandFinancialAdvisorName DEALER NAME (PLEASE PRINT) DEALER # FINANCIAL ADVISOR NAME (PLEASE PRINT) FINANCIAL ADVISOR # 7. AnnualAccountFees-Themethodchosenbelow(excluding Invoice the Employer/Plan Sponsor)willapplytoallofyourannualfee accountswithB2BBankFinancialServicesInc.("B2BBFSI")andreplacesanypreviouslychosenmethod. I request that my annual account fees, until I direct otherwise in writing, be collected from (select one): You do not need to complete this section. For as long as your loan remains active, you will not be charged annual account fees. A r Mychequingaccount Section 8 (Not required) 8. BankingInformation-ForinvestmentaccountswithCo-Applicants,ifthebankaccountisnotinalltheApplicant’snames,banking If your mutual fund(s) pay you cash distributions, complete the Letter of Direction for Cash Distributions included in your package. Section 9 (Mandatory) Complete parts 1 and 2 of this section Void cheque required. This bank account will be used each year, on or about June 1, for withdrawal of annual account fees, which will vary based on the applicable fee schedule provided.UnpaidfeeswillbecollectedfromyourB2BBFSIaccount(s).Pleaseseetheattached Pre-Authorized Debit (PAD) Terms & Conditions for more information on the CPA Rule H1 Requirements that apply to this fee payment option. B r Myindividual(notjointorITF)B2BBFSIinvestmentaccount If an individual investment account does not exist, option C will apply. C q MyB2BBFSIregisteredaccount(s),uptothefeeapplicableperaccount,then frommyB2BBFSIinvestmentaccount(s),ifany. D q InvoicetheEmployer/PlanSponsor(Available for Group accounts only.) UnpaidfeeswillbecollectedfromyourB2BBFSIaccount(s). informationisrequiredforeachApplicant(pleasesubmitonaseparatesheet) 0 BANK NUMBER TRANSIT NUMBER ACCOUNT NUMBER ADDRESS NAME OF CANADIAN FINANCIAL INSTITUTION CITY PROVINCE POSTAL CODE 9. ShareholderCommunicationInformation Ihavereadandunderstandthetermsunderthesection“NationalInstrument54-101ExplanationToClients”disclosedonthereverseofthisapplication. Iagreethatthechoicesindicatedbymeapplytoallofthesecuritiesheldintheaccount. Part1-ReceivingSecurityholderMaterials Pleasemarkthecorrespondingboxtoshowwhatmaterialsyouwanttoreceive.Securityholdermaterialssenttobeneficialownersofsecuritiesconsistofthefollowingmaterials:(a)proxy-relatedmaterialsfor annualandspecialmeetings;(b)annualreportsandfinancialstatementsthatarenotpartofproxy-relatedmaterials;and(c)materialssenttosecurityholdersthatarenotrequiredbycorporateorsecuritieslawto be sent. r IWANTto receiveALLsecurityholdermaterialssenttobeneficialownersofsecurities. ✔ IDECLINE to receive ALLsecurityholdermaterialssenttobeneficialownersofsecurities.(EvenifIdeclinetoreceivethesetypesofmaterials,Iunderstandthatreportingissuerorotherpersonorcompanyis r entitled to send these materials to me at its expense). r IWANT to receive ONLY proxy-related materials that are sent in connection with a special meeting. (Importantnote:Theseinstructionsdonotapplytoanyspecificrequestyougiveormayhavegiventoareportingissuerconcerningthesendingofinterimfinancialstatementsofthereportingissuer.Inaddition, insomecircumstances,theinstructionsyougiveinthisclientresponseformwillnotapplytoannualreportsorfinancialstatementsofaninvestmentfundthatarenotpartofproxy-relatedmaterials.Aninvestment fundisalsoentitledtoobtainspecificinstructionsfromyouonwhetheryouwishtoreceiveitsannualreportorfinancialstatements,andwhereyouprovidespecificinstructions,theinstructionsinthisformwith respecttofinancialstatementswillnotapply.) Part2-DisclosureofBeneficialOwnershipInformation Please mark the corresponding box to show whether you DO NOT OBJECT or OBJECT to us disclosing your name, address and securities holdings to issuers of securities you hold with us and to other persons or companies in accordance with securities law. r IDONOTOBJECT to you disclosing the information described above. ✔ IOBJECT to you disclosing the information described above. r 225-07-504E (01/01/2014) Page 2 of 4 How to complete the enclosed Investment Account Application — Page 3 Section 10 (Not required) You do not need to complete this section. Section 11 (Mandatory) 10. IdentityVerification(FederalLegislation*)-attachphotocopiesofID: NAME ID CODE ID REFERENCE # NAME ID CODE ID REFERENCE # 11. AccountInformation Indicate “No” or “Yes” to each question in this section and provide an account number, if required. Section 12 (Mandatory) Read the Account Agreement and then sign and date this section. If you have a co-applicant, they must sign and date the application too. a) Is this Account to be used by or on behalf of a third party(ies)? This includes a personwhohasafinancialinterestintheAccountorwhoexertscontrolover the assets in the Account. If Yes, please complete and attach the supplemental form – Third Party Determination Statement. b) Doesanyoneotherthanyou,theApplicant(s),haveanyfinancialinterestin this account? ) (If Yes, name the party c) Do you, the Applicant(s), wish to appoint another person(s) to have full power and authority over your account? (If yes, attach a completed Power of Attorney, which must include the signature of and banking information – as in Sections 8 & 10 – on the authorized individual) ✔ NO q YES q Doyouhaveanyaccountswithotherbrokeragefirms? e) Doyou,theApplicant(s),controlthetradinginanyotherB2BBFSIaccounts? (If yes, indicate account numbers below): Account type(s): RRSP Account # NO ✔ YES r ✔ NO q YES q Account # ✔ NO q YES q 12. AccountAgreement–pleaseensureallapplicantssignthissection. PLEASEREADTHEACCOUNTAGREEMENTANDTHEDEPOSITTERMSANDCONDITIONSATTACHEDTOTHISAPPLICATIONFORIMPORTANTTERMSANDCONDITIONSTHATAPPLYTO YOURACCOUNTANDDEPOSIT. I/We acknowledge that I/we have read and agree to be bound by the Account Agreement terms and conditions attached to this application. I/We undertake to advise my/our Dealer in writing of any change to the information in this application. I/We acknowledge that I/we have read and agree to be bound by the attached Pre-Authorized Debit (PAD) Terms and Conditions. Privacy Protection - By signing this application form below, I/we acknowledge reading the Privacy Protection Notice attached to this application and I/we consent to my/our personal information being collected, held, used and disclosed (i) by each company with whom I/we have an account in the ways and forthepurposesidentifiedinthePrivacyProtectionNoticeand(ii)bytheIntroducerDealerasnecessary for the purpose of carrying out the functions described in clause (b) of the Account Agreement attached tothisapplication.IfI/wehaveprovidedinformationconcerninganyotherperson,I/weconfirmthatI/we am/are authorized to provide such information. X Robert Smith SIGNATURE OF APPLICANT X SIGNATURE OF CO-APPLICANT If you have an advisor, they may complete this section. If not, leave it blank. r d) ✔ NO q YES q I/We hereby certify that the information indicated above is complete and accurate. Section 13 (Optional for your advisor to complete) YYYY / MM / DD SelectIDCode=1=Driver’sLicense,2=Passport,3=BirthCertificate(onlyifunderage21) PLACE OF ISSUE EXPIRY DATE * Notes: 1. Tocomplywithapplicablelaw,informationmustbeobtainedfromallindividualsauthorizedtogiveinstructionsontheaccountandcertainbeneficialownersoftheclientandtheiridentitiesmustbe verified.Pleaseattachtheapplicableadditionalforms. 2. Pleasecompletetheidentityverificationforeachpersonwithauthorityoveroranyfinancialinterestintheaccount. 3. Foradditionalaccountholders,attachaseparatesheettorecordthebankinginformationandtheidentityverificationinformationforsuchpersons. To:B2BBankFinancialServicesInc.(“B2BBFSI”)andB2BBank:IfI/wemakeaDepositwithB2BBank,or any of its affiliates (including their successors and assigns), I/we acknowledge I/we have read and agree to theattachedDepositTermsandConditions(capitalizedtermsareasdefinedintheattachedDepositTerms andConditions).I/WeacknowledgethatB2BBank,oranyofitsaffiliates(includingtheirsuccessorsand assigns) may pay my/our Dealer an upfront commission for Term Deposits and a trailing commission for Non-Term Deposits, each based on the value of any such Term Deposit or Non-Term Deposit as described in the attached Deposit Terms and Conditions. For a Cash Deposit held in a tax-deferred account (either registeredornon-registered),B2BBank,oranyofitsaffiliates(includingtheirsuccessorsandassigns), maypayB2BBFSIafeenogreaterthantheamountwhichisthedifferenceintheinterestratebetween theprimerateofinterest(whichisvariable,subjecttofluctuation,andpostedonb2bbank.com),andthe effectiverateofinterest(ifany)applicabletomy/ourCashDeposit,calculatedonthebalanceofmy/our Cash Deposit on a daily basis. The maximum commissions and fees referenced herein and the Deposit Terms and Conditions may change from time to time with Notice to me/us. X / MM / )DD (YYYY Y Y Y Y/ M M/DD DATE X MM (YYYY Y Y Y Y/ M/ M / D D/ )DD DATE (2014 Y Y Y Y/ /M M01 / D /D )30 DATE SIGNATURE OF CO-APPLICANT / MM (YYYY Y Y Y Y/ M M / D D/ )DD DATE SIGNATURE OF CO-APPLICANT 13. Dealer/FinancialAdvisorInformation a) Do you have a direct or indirect interest in the Account other than an interest in commissions charged? (If yes, give details in Financial Advisor’s Comments) q NO q YES Financial Advisor’s Comments: b) Are you registered in the province in which the Applicant(s) resides? q NO q YES q NO q YES SIGNATURE OF FINANCIAL ADVISOR c) Have you personally met the Applicant(s)? If yes, when? Has a credit check been done? If Yes, what was the result (check one) X ( YYYY Y Y Y Y/ M/ MMM / D D/ )DD DATE X q Personal Contact q Walk In q Referral q NO q YES q Acceptable ( Y Y Y Y//MMM M / D /DDD ) Date YYYY Referral by: f) MM (YYYY Y Y Y Y/ M/ M / D D/ )DD DATE BRANCH MANAGER’S APPROVAL d) How long have you known the Applicant(s) e) How did you come to know the Applicant(s)? q Advertising Lead q Phone-In X q Not Acceptable MM (YYYY Y Y Y Y/ M/ M / D D/ )DD DATE PARTNER’S OR DIRECTOR’S ACCEPTANCE Initialorder: q Buy or Amount $ q Sell q Solicited or q Unsolicited Description 225-07-504E (01/01/2014) Page 3 of 4 How to complete the enclosed Transfer Authorization The information you will need to complete this form is available on statements from the mutual fund company/companies. Speak with one of our Client Service Representatives at 1.800.387.2087 if you require assistance or, contact your advisor. Note: Complete one form for each mutual fund company that holds the pledged collateral for your loan. Transfer Authorization for Non-Registered Investments DEALER SERVICES Section A (Mandatory) Complete all information in this section A: Client Identification • Thisformcanbeusedtotransfernon-registeredaccountswithexternalfinancialinstitutions. • Dataenteredonthisformmaybescannedandstoredelectronically. • Pleaseprintneatlytoensurecompleteness,accuracyandmachine-readability. Account/Policy Holder Last Name Robert HomeTelephoneNumber ( 555 ) 123-4567 123 Any Street Province Toronto Section B (Mandatory) In this section, simply complete the Account Type information. 999-999-999 Address City B: Receiving Institution Information Initial(s) Social Insurance Number First Name Smith Postal Code ON ✔ B2B Bank Financial Receiving Institution Name Postal Code M5L 0A3 ON Client Account/Policy Number Fax Number ( 416 ) 979-0638 FOR BBS DELIVERIES ONLY USE FINS #T080 Dealer Name Financial Advisor # ✔ Individual Dealer Account Number BusinessTelephoneNumber Business Fax Number ) ( ) ✔ These assets are collateral for a B2B Bank investment loan Estate Corporation UnincorporatedOrganization Joint Rights of Survivorship TenantsInCommon(TIC) InTrustFor Dealer Number ( Account Type (Check one only) C: Client Direction to Relinquishing Institution CLIENT SERVICES ( 416 ) 964-0028 Province TORONTO Section C (Mandatory) Contact Name TelephoneNumber 199 BAY STREET, SUITE 610 PO BOX 35 STN COMMERCE COURT Financial Advisor Name Please provide: • Relinquishing Institution Name (the name of the mutual fund company) • Client Account number B2B Bank Securities ServicesInc.(IIROC) Address City For use by Dealers only ( 555 ) 957-6543 A1A 2B2 B2B Bank Intermediary ServicesInc.(AMF) ServicesInc.(MFDA) BusinessTelephoneNumber FormalTrust Relinquishing Institution Name ABC Mutual Fund Company Address Client Account/Policy Number 12345-67 City Province Postal Code Transfer: (check one box only for asset transfer instructions) ✔ All in kind (as is) All in cash* All assets*, but mixed in cash and in kind; see list below or attached list Partial*; see list below or attached list *Please refer to statement in bold in Client Authorization section below. Investment Amount Section D (Mandatory) You (and any co-applicant) must sign and date this form. Your dealer and financial advisor’s name is optional. D: Client Authorization In Kind Shares/Units In Cash Dollars In Kind Shares/Units In Cash Dollars In Kind Shares/Units In Cash Dollars In Kind Shares/Units In Cash Dollars Symbol and/or Certificate Number or Policy Number Investment Description Iherebyrequestthetransferofmyaccountanditsinvestmentsasdescribedabove. *WHERE I HAVE REQUESTED A TRANSFER IN CASH, I AUTHORIZE THE LIQUIDATION OF ALL OR PART OF MY INVESTMENTS AND AGREE TO PAY ANY APPLICABLE FEES, CHARGES OR ADJUSTMENTS. Robert Smith X X AUTHORIZEDCLIENTSIGNATURE(MANDATORY) AUTHORIZEDCLIENTSIGNATURE(MANDATORY) FINANCIALADVISORNAME DEALERNAME DEALER # ADVISOR# 2 0 1 4 0 1 3 0 Y Y Y Y M M D D FORWARD TO B2B BANK DEALER SERVICES FOR PROCESSING B2BBankDealerServicesincludesB2BBankFinancialServicesInc.(anMFDAmember),B2BBankSecuritiesServicesInc.(anIIROCmember,Member-CanadianInvestor ProtectionFund)andB2BBankIntermediaryServicesInc.(anAMF-regulateddealeroperatinginQuebec).B2BBankisatrademarkusedunderlicense. 100-06-244E (01/22/2014) Additional copies of the Transfer Authorization for Non-Registered Investments are available at b2bbank.com/dealerservices Page 4 of 4