SEGREGATED FUND TRADE TICKET

1 SEGREGATED fund NEW CLIENT PURCHASE SWITCH TRANSFER. TRADE TICKET EXISTING CLIENT REDEMPTION RED/PUR/CONVERSION. Dealer: 3057. SECTION 1 - PLAN REGISTRATION. Individual Individual ITF Joint JTWROS Joint JTIC Joint ITF Corporate Estate Formal Trust SECTION 2 - PLAN TYPE. Non-Registered RRSP RESP RRIF LIRA TFSA SRSP RDSP LIF (OTHER) _____. Plan ID _____. SECTION 3 - CLIENT INFORMATION. M M D D Y Y Y Y. First Name Last Name Date of Birth Social Insurance Number M M D D Y Y Y Y. First Name of Joint Applicant Last Name Date of Birth Social Insurance Number Street Address RESP/RDSP/IN TRUST FOR/BENEFICIARY ITF.

2 City-Town Province M M D D Y Y Y Y. Date of Birth Social Insurance Number Postal Code Tel. Residence Tel. Business Corp. SECTION 4 - TRADING INSTRUCTIONS AMOUNT LEGEND: A = All D = Dollars P = Percentage S = Shares T = 10% Free Shares M = Matured Shares REDEMPTION / SWITCH FROM PURCHASE/SWITCH TO. fund Code Amt Type Amount Gross/Net Wire Order # fund Code Amt Type Amount Sales Charge Wire Order #. fund Name Account # fund Name Account #. fund Name Account # fund Name Account #. fund Name Account # fund Name Account #.

3 fund Name Account # fund Name Account #. fund Name Account # fund Name Account #. Transactions processed by fund code only SECTION 5 - REDEMPTION INSTRUCTIONS Make cheque payable to: Client Deposit to bank account as per new void cheque Forward to Client as per mailing address on file WFGIA -(ITF) forward via ICS to: Deposit to bank account as per existing void cheque 400 Applewood Crescent, 3rd Floor, Vaughan, Ontario L4K 0C3. SECTION 6 - SPECIAL INSTRUCTIONS. SECTION 7 - CLIENT ACKNOWLEDGEMENT AND consent .

4 Did you borrow funds to purchase investment? Yes No If Yes, did you review the disclosure document on the back of this TRADE TICKET Yes Have you been advised of and are comfortable with all risks associated with leveraged investing? Yes I have received, read and understand the information folder. I am aware of any and all fees that I may be responsible for. I/we the undersigned confirm that I/we have been informed of the disclosures and disclaimers described on the reverse and declare that I /we understand the charges, terms, conditions and provisions stated therein.

5 I/We have read and fully understand the Your Personal Information section on the reverse and acknowledge and consent to the collection , use and disclosure of my/our personal information by World Financial Group Insurance Agency of Canada Inc. for the purposes identified in therein. Your consent relating to the use of your personal information to provide you with details about other insurance and fi nancial services and products is optional. If you do not wish your personal information to be used for this optional purpose, check here ____ or you can write to us at: World Financial Group Insurance Agency of Canada Inc.

6 Attn: Privacy Offi cer, 5000 Yonge Street, Suite 800, Toronto, ON M2N 7E9. CLIENT DATE. X X Signed in the Province of M M D D 2 0 1. Client Signature Joint Client Signature (if applicable) (Required). SECTION 8 - AGENT ACKNOWLEDGEMENT. I confirm that I witnessed the client sign this TRADE TICKET and that the client is the individual identified in the associated NAAF/KYC Form X. Agent Initials (Required). X X AGENT DATE. Writing Agent - Print Name Writing Agent Signature Agent # Agent %. M M D D 2 0 1. X X. Split Agent - Print Name Split Agent Signature Split Agent # Split Agent %.

7 *W305713*. Cheques must be payable to World Financial Group In Trust and not directly to an agent. ORIGINAL --WFG. ORIGINAL WFGD ealer DealerConnect/Fundex Connect/Fundex 2nd 2nd Copy Copy -- Agent File 3rd Copy Branch/Location 3rd-Copy Client- Client SEGREGATED fund Contract Application - Disclosures and Disclaimers All the details of the contract benefits and provisions that you should know about this SEGREGATED fund You have a medium to high tolerance for risk contract are contained in the Information Folder and Policy Contract.

8 Please refer to them and review any You should be comfortable with the risk of borrowing for investment purposes. This strategy is not questions you have with your agent. appropriate for conservative investors, whose profiles call for investments with a low level of risk. This Please note that the value of your contract can go up or down subject to the guarantees. Any withdrawals strategy is more suitable for investors with long-term investment horizons (5 to 10 years). It is not suitable you make will reduce your guarantees.

9 For full details please refer to the appropriate section of the for older investors or those approaching retirement who seek to maximize income and preserve capital. Insurer's Information Folder and the SEGREGATED funds contract. Also, note that the contract maturity dates Your tax rate is fairly high establishes when the contract guarantees will come into effect. Borrowing money to purchase a SEGREGATED fund is particularly suitable for investors with fairly high tax SEGREGATED funds are investment products.

10 The performance of the investment options available in rates because the interest payable on the loan is tax deductible. However, borrowing is not necessarily a SEGREGATED funds is not guaranteed. You should carefully consider your tolerance for risk when you good strategy based solely on tax benefits. You should not consider only this criterion when deciding select an investment option. Other critical factors to consider are your investment time horizon; your whether or not to use leveraging. investment knowledge and your investment objective.