TO BE COMPLETED BY CURRENT AND NEW …

1 1 500-5000 Yonge Street Toronto, ON M2N 7J8 5/19 Notice of Transfer of Ownership for insurance ProductsInstructions: This form should be used to transfer ownership of your insurance policy. If this is an amalgamation or a name change, do not complete this form, please refer to the Policy Service application (PS339) Section 10 for more HAVE (SELECT APPLICABLE PRODUCT)COMPLETE THE FOLLOWING SECTIONSADDITIONAL INFORMATION Universal Life policy/Cash value policy owned by: Individual Entity This transaction may cause a taxable consequence Section 1 6 Sign in Section 7 Advisor to complete and sign Section 8 Where owner is an Entity (corporate, non-corporate, trust, you must also submit a fully COMPLETED Policy Ownership For Corporate and Non-Corporate Entities or trust form (IP-LP1747)Under Quebec, Ontario, Manitoba, Alberta and British Columbia laws, if the beneficiary is revocable, this transfer of ownership terminates the existing beneficiary designation.)

2 The new Owner(s) should complete the Change of Beneficiary form (PS367), otherwise the policy proceeds become payable to the new Owner(s) or his/her estate. Term PolicyThis transaction may cause a taxable consequence Section 1, 2, 3 Sign in Section 7 Under Quebec, Ontario, Manitoba, Alberta and British Columbia laws, if the beneficiary is revocable, this transfer of ownership terminates the existing beneficiary designation. The new Owner(s) should complete the Change of Beneficiary form (PS367), otherwise the policy proceeds become payable to the new Owner(s) or his/her estate. Critical Illness Policy Section 1 and 2 Sign in Section 7In certain provinces if the beneficiary is revocable, this transfer of ownership terminates the existing beneficiary designation.

3 The new Owner(s) should complete the Change of Beneficiary form PS367, otherwise the policy proceeds may be payable to the Life BE COMPLETED BY CURRENT AND NEW OWNERSS ection 1 Policy InformationPolicy number: (the Policy ) issued or assumed by ivari (herein called the Company )Life insured(s): CURRENT Owner(s): Owner s CURRENT address: MULTIPLE OWNERSi) Canadian provinces (excluding Qu bec) The policy will be owned by all Owners with Right of Survivorship should an Owner die while the policy is in effect, the deceased Owner s interest automatically transfers to the surviving Owner(s) unless the Tenants in Common option is selected below. Tenants in Common should an Owner die while the policy is in effect, the deceased Owner s interest will transfer to his/her estate unless a Contingent Owner has been named for such ) Province of Qu bec only Ownership must be Tenants in Common.

4 Tenants in Common (undivided co-ownership) means that should an Owner die while the policy is in effect, the deceased Owner s interest will transfer to his/her estate. (Please name one another as Contingent Owners if Right of Survivorship is desired).2 Notice of Transfer of Ownership for insurance ProductsSection 2 Owners For good and sufficient consideration, all right, title and interest (all ownership rights) of the undersigned in this policy are hereby transferred to:NEW OWNER 1 Last name First name Date of birth (DD/MM/YYYY)Address (Street number and name) Apt. Telephone numberCity Province Postal code Country SIN Relationship to Insured Relationship to CURRENT OwnerOwner s email address**Identification document Identification document number Document expiry date (MM/YYYY)Issuing jurisdiction and country Please refer to an original, non-expired government issued photo , such as passport, provincial health card (except in AB, PEI, ON and MB), driver s licence or Age of Majority.

5 OccupationIn what industry are you employed?**For a list of valid industries refer to and search for form number (IP-LP1971).Declaration of tax residency Please answer the following three statements. Depending on your situation, you may answer yes to more than ) I am a tax resident of Canada.. Yes No b) I am a tax resident or a citizen of the United States.. Yes No Please provide your taxpayer identification number (TIN) from the United States: If you do not have a TIN from the United States, have you applied for one? .. Yes No c) I am a tax resident in a country other than Canada or the United States.. Yes No If yes , to statement c), provide your country of tax residence and taxpayer identification numbers (TIN).

6 If you do not have a TIN for a specific country, give the reason using one of these choices: Reason 1: I will apply or have applied for a TIN but have not yet received it. Reason 2: My country of residence does not issue TINs to its residents. Reason 3: Other reason, provide OF TAX RESIDENCETAXPAYER IDENTIFICATION NUMBER (TIN)IF NO TIN, PROVIDE REASON 1, 2 OR 3 POLICY OWNERSHIP APPLIES TO ALL COVERAGES. THE OWNER MUST BE AT LEAST 16 YEARS OF AGE (AT LEAST 18 YEARS IN THE PROVINCE OF QU BEC)MANDATORY FOR CASH VALUE POLICIES ( UNIVERSAL LIFE POLICY)3 Notice of Transfer of Ownership for insurance ProductsSection 2 Owners (cont d)For good and sufficient consideration, all right, title and interest (all ownership rights) of the undersigned in this policy are hereby transferred to:NEW OWNER 2 Last name First name Date of birth (DD/MM/YYYY)Address (Street number and name) Apt.

7 Telephone numberCity Province Postal code Country SIN Relationship to Insured Relationship to CURRENT OwnerOwner s email address**Identification document Identification document number Document expiry date (MM/YYYY)Issuing jurisdiction and country Please refer to an original, non-expired government issued photo , such as passport, provincial health card (except in AB, PEI, ON and MB), driver s licence or Age of Majority. OccupationIn what industry are you employed?**For a list of valid industries refer to and search for form number (IP-LP1971).Declaration of tax residency Please answer the following three statements. Depending on your situation, you may answer yes to more than ) I am a tax resident of Canada.

8 Yes No b) I am a tax resident or a citizen of the United States.. Yes No Please provide your taxpayer identification number (TIN) from the United States: If you do not have a TIN from the United States, have you applied for one? .. Yes No c) I am a tax resident in a country other than Canada or the United States.. Yes No If yes , to statement c), provide your country of tax residence and taxpayer identification numbers (TIN). If you do not have a TIN for a specific country, give the reason using one of these choices: Reason 1: I will apply or have applied for a TIN but have not yet received it. Reason 2: My country of residence does not issue TINs to its residents.

9 Reason 3: Other reason, provide OF TAX RESIDENCETAXPAYER IDENTIFICATION NUMBER (TIN)IF NO TIN, PROVIDE REASON 1, 2 OR 3 POLICY OWNERSHIP APPLIES TO ALL COVERAGES. THE OWNER MUST BE AT LEAST 16 YEARS OF AGE (AT LEAST 18 YEARS IN THE PROVINCE OF QU BEC)MANDATORY FOR CASH VALUE POLICIES ( UNIVERSAL LIFE POLICY)4 Notice of Transfer of Ownership for insurance ProductsSection 3 Tax information MANDATORY FOR ALL PRODUCTSA transfer of ownership is considered to be a disposition for tax purposes and may have tax consequences based on the relationship between the CURRENT and new owners. The information in this section will be used to determine the taxable implication and therefore, it is important that you complete this section accurately.

10 If you are unsure on how to complete this section or want to better understand the different tax consequences, please contact your independent financial advisor, your tax/legal advisor or refer to and click Got a Question .If you are transferring the insurance policy under a different circumstance other than the scenarios noted below, please enclose a separate written request outlining the details of that transaction. The tax implication on transfer of ownership will be calculated on the day the transaction is processed in ivari s Head answer section a) or b) depending on the parties involved in the transfer of ownership, and section c). NEW OWNER 1 YES NO NEW OWNER 2 YES NOa) Complete this section if the transfer is between individuals and proceed to section c) i) From parent to child.