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26709 OPR 23861 - TFSA application form - new …

application FORMTax-free savings accountSUCCESSOR HOLDER AND/OR BENEFICIARY(IES) INFORMATION (optional)INVESTMENT SELECTION(cash purchase/in-kind transfer) Fund codes available at In the event of a discrepancy between the code and the name, we will treat the code as correct and process INVESTMENT PROFESSIONALfor all transactionsTYPE OF ACCOUNTNote: All payments out of the account will be made to the registered owner(s).HOLDER INFORMATION (all information is mandatory)Fund Code Fund Name Amount $ % Sales Charge % (ISC only) Wire Order Number TOTAL INVESTMENT AMOUNT $ New accountFidelity account no. Dealer Cross Reference no. Dealer company s name Dealer code Rep. codeInvestment professional s name Phone #You must be a Canadian resident and 18 years of age or older to contribute to a TFSA. Mr. Mrs. Dr. Ms. Miss Last Name First Name Initial Date of Birth SIN Home Phone Work Phone (optional)(dd/mm/yyyy)Email address Cell phone Street Address Apt/Suite English City Province Postal Code FrenchApplication for Tax-Free Savings AccountFor all provinces and territories except Quebec: The validity of a successor holder/beneficiary designation is subject to provincial/territorial succession legislation.

eDELIVERY An eDelivery notification will be sent to the email addresses provided in the “Account holder information” section of the application form.

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Transcription of 26709 OPR 23861 - TFSA application form - new …

1 application FORMTax-free savings accountSUCCESSOR HOLDER AND/OR BENEFICIARY(IES) INFORMATION (optional)INVESTMENT SELECTION(cash purchase/in-kind transfer) Fund codes available at In the event of a discrepancy between the code and the name, we will treat the code as correct and process INVESTMENT PROFESSIONALfor all transactionsTYPE OF ACCOUNTNote: All payments out of the account will be made to the registered owner(s).HOLDER INFORMATION (all information is mandatory)Fund Code Fund Name Amount $ % Sales Charge % (ISC only) Wire Order Number TOTAL INVESTMENT AMOUNT $ New accountFidelity account no. Dealer Cross Reference no. Dealer company s name Dealer code Rep. codeInvestment professional s name Phone #You must be a Canadian resident and 18 years of age or older to contribute to a TFSA. Mr. Mrs. Dr. Ms. Miss Last Name First Name Initial Date of Birth SIN Home Phone Work Phone (optional)(dd/mm/yyyy)Email address Cell phone Street Address Apt/Suite English City Province Postal Code FrenchApplication for Tax-Free Savings AccountFor all provinces and territories except Quebec: The validity of a successor holder/beneficiary designation is subject to provincial/territorial succession legislation.

2 For the Province of Quebec: Under the laws of Quebec, a designation of successor holder/beneficiary may be made in a will or other written document that meets the requirements of a testamentary disposition. The successor holder/beneficiary designation made on this application cannot be given effect and will be defaulted to the Designation of successor holder (for all provinces and territories, except Quebec)In the event of my death, I designate my spouse or common-law partner, by naming them below, to be the successor holder of the Plan. If I have designated both successor holder and beneficiary (under Designation of Beneficiary(ies) section below), and both are alive at my death, then the successor holder designation takes precedence. The successor holder may, after my death, revoke or change the beneficiary(ies).Last Name First Name SIN2. Designation of beneficiary(ies) (for all provinces and territories, except Quebec)If I have designated my spouse as successor holder, the following beneficiary designation will be effective only if my successor holder predeceases me or is not my spouse or common-law partner on the date of my death.

3 I designate the person(s) named below as the beneficiary(ies) under the Plan, provided this person(s) is living at the date of my death. If a beneficiary I have designated below dies before, then that beneficiary s percentage entitlement will be shared among any other beneficiary(ies) I have designated who survive me, in proportion to their percentage entitlement. If I do not designate any beneficiaries, payment will be made to my estate. I reserve the right to revoke this designation. I understand that I must deliver any change to my beneficiary designation to Fidelity in writing, in a form acceptable to Name First Name Relationship Allocation %Caution: Your successor holder/beneficiary designation will remain unchanged on our records until you make a change by notifying us in writing. You should reconsider your successor holder/beneficiary designation if there are changes in your personal circumstances, such as marriage or divorce.

4 Cheque attached Transfer from an existing Fidelity Account Transfer from another TFSA Other, please specifyT-SWP PAYMENTS AND DISTRIBUTION WITHDRAWAL (DWP) For direct deposit it may take up to 48 hours to post on your bank EXCHANGES optional Fund code takes priority over fund name. Only available between the same load option.* The last run date is the actual last systematic exchange PURCHASES (PAC)optionalNote: 10 business days are required before the start date to set up or change a PAC plan. If your PAC date does not fall on a business day, Fidelity will process the PAC on the next business day. Fund code takes priority over fund name. Attach personalized void cheque. It may take up to 48 hours for funds to be withdrawn from your bank account from the date the PAC is scheduled to run.* The last run date is the last date funds will be withdrawn from your bank WITHDRAWALS (SWP)optionalNote: 10 business days are required before the start date to set up or change a SWP plan.

5 If your SWP date does not fall on a business day, Fidelity will process the SWP on the preceding business day. Fund code takes priority over fund name. Attach personalized void cheque.* The last run date is the last date funds will be deposited to your bank INFORMATIONfor PAC, SWP, DWP payments (Attach personalized void cheque)Bank Account Holder Signature Joint Bank Account Holder Signature FREQUENCY OPTIONS (choose one) Last run date* Weekly Every 2 Weeks Monthly Twice a Month Every 2 Months Quarterly Semi-annually Annually one time I authorize Fidelity to exchange funds within my Fidelity account as follows:FREQUENCY OPTIONS (choose one) Last run date* Weekly Bi-Weekly Monthly Twice a Month Every 2 Months Quarterly Semi-annually AnnuallyDistributions will be reinvested unless otherwise indicated below. You can choose to have distributions directly deposited to your bank account or sent via note that for T-SWP series and/or a series of a fund that pays monthly distributions at a fixed rate, the default option will be cash/cheque unless otherwise stated.

6 Pay cash distributions on all funds Only pay cash distributions on the following funds (list fund codes)PAYMENT OPTION Deposit to my bank account (attach void cheque) Mail cheque to address on fileStart Date Second Run Date Amount ($) For twice a month (dd/mm/yyyy) only (dd/mm/yyyy) Fund Code Fund Name Net Gross Payment by TOTAL DOLLAR AMOUNT $ I authorize Fidelity to make regular withdrawals from my Fidelity account as shown OPTIONS (choose one) Last run date* Weekly Every 2 Weeks Monthly Twice a Month Every 2 Months Quarterly Semi-annually Annually Direct Deposit (attach void cheque) Cheque to You For direct deposit it may take up to 48 hours to post on your bank CONFIDENTIAL INFORMATIONS tart Date Second Run Date From Fidelity Fund Amount To Fidelity Fund For twice a month (dd/mm/yyyy) only (dd/mm/yyyy) Fund Code Fund Name $ Units Fund Code Fund Name Start Date Second Run Date For twice a month (dd/mm/yyyy) only (dd/mm/yyyy) Fund Code Fund Name Amount ($) ISC Sales Charge % TOTAL DOLLAR AMOUNT $attach personalized void cheque here I authorize Fidelity Investments to debit the bank account indicated on the attached void cheque for the amount(s) and in the frequencies indicated below.

7 If I transfer my account to a different branch of the same institution, this authorization will still be valid. Failure to make the payment will not give rise to any liability for Fidelity Investments. I may change these instructions or cancel this plan at any time, provided Fidelity Investments receives at least 10 business days notice by phone or by mail. I have certain recourse rights if a debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this preauthorized debit agreement (PAD). (To obtain more information on recourse rights and/or a sample of a cancellation form , or more information on your right to cancel a PAD agreement, contact your financial institution or visit ) By Canadian Payment Association definition, if this is for your own personal investment, your debit will be considered a Personal PAD.

8 If this is for business purposes, it will be considered a Business PAD. By signing this form , I hereby waive any pre-notification requirements as specified by section 15(a) and (b) of the Canadian Payments Association Rule H1 with regards to pre-authorized debits. I confirm that all persons whose signatures are required to authorize transactions in the bank account, as per the attached void cheque, have signed this agreement eDelivery notification will be sent to the email addresses provided in the Account holder information section of the application form . You must provide Fidelity a valid email addresses and notify Fidelity of any future changes to the email SIGNATUREfor all transactionsApplication for Tax-Free Savings AccountRegister my account(s) for eDeliveryConfirmation, Statements, Tax slips/receipts and Annual regulatory noticeIf you selected Online delivery of your account documents, please check the box below to accept the terms and read the eDelivery agreement acknowledge that I have received a copy of the current fund facts of the fund(s) selected and understand that these transactions are made under the terms and conditions therein.

9 I understand that mutual funds are not insured under the Canada Deposit Insurance Corporation Act or la R gie de l assurance-d p ts du Qu bec. I certify that the information provided by me on this application is complete and true in all respects. I request that this application and all documentation relating to my account or Plan be provided to me in English. Je vous prie de me faire parvenir la pr sente demande ainsi que toute la documentation aff rente mon compte ou mon R gime en : Computershare Trust Company of Canada (The Trustee ) I request Computershare Trust Company of Canada to act as Trustee of my Fidelity Investments Tax Free Savings Account (the Plan ) and to file an election with the Minister of National Revenue to register my qualifying arrangement under section of the Income Tax Act (Canada). I acknowledge and agree to be bound by the terms and conditions set out in the Declaration of Trust set forth on the reverse side hereof, as amended from time to time.

10 I acknowledge that I am solely responsible for determining the amount of contributions to the Plan. I understand that I am responsible for notifying the Trustee when I become a non-resident for Canadian tax purposes. I acknowledge that I am solely responsible and liable for certain tax consequences arising in connection with the Plan being non-compliant with the Income Tax Act (dd/mm/yyyy) Your Signature/ Holder s Signature Authorized Signature X X00/000/0000 Fidelity Investments application form eDelivery Terms and ConditionsI/we acknowledge the following: By selecting Online delivery for my Confirmations, Statements, Tax slips/receipts and Annual regulatory notice ( Account Documents ), I/we am/are consenting to receiving electronic notification when the Account Documents are available online through the Fidelity website (eDelivery).


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