Please use this form to set up RRSP's/RESP's/TFSA's/FHSA's & LIRA Investments. Do not use this form if you are applying for the Investment Loan Leverage strategy.

PERSONAL INFORMATION

Product Requested

Contribution Amount

First Payment Date (Requested)

First Name

Last Name

Phone *

Email *

SIN *

Country of Birth *

Date of birth *

Address *

Postal code *

How long at this address? *

EMPLOYMENT AND NET WORTH

Employer *

Employment Status *

Employer Address *

Income per year *

Years / Months with Current Employer *

Employment - Industry *

Job Title *

Previous Employer (If less than 5 years with current employer)

Years / Months with Previous Employer

Mortgage Bank / Landlord *

Mortgage Balance / Rent Payment ($0.00 if Not Applicable) *

Assets *

Liabilities *

BENEFICIARIES

Beneficiaries Names, Relationship, Birthdates (mm/dd/yyyy), Percentage(s) *

Backup Beneficiaries

Additional Notes

Primary ID / Drivers Licence

Secondary ID / Other Government Issue ID

Void Cheque

INVESTOR PROFILE QUESTIONS

The questions in this investor profile questionnaire were designed to help you understand your investment objectives and your investment personality. You may use this service to support your investment-making decision or to select an allocation tailored to your needs. As you answer the following questions, remember there is no right or wrong answer. However, keep in mind that you must be completely candid, or the results won’t reflect your true investment personality. Please answer each question and find your score in the box next to each answer. Your total score will help you define your investment profile. If you have more than one account, please consider filling out one questionnaire for each account. Each account you hold may have a different purpose, which may affect your investment decisions.

INVESTMENT HORIZON

1. Which of the following ranges includes? your age *

2. When do you plan to start withdrawing at least 25% of your savings? *

(1 Point) In less than a year

(2 Points) Between 1 and 3 years

(5 Points) Between 4 and 5 years

(10 Points) Between 6 and 9 years

(20 Points) In over 10 years

3. Over the next five years, you plan to: *

(1 Point) Make withdrawals from your capital (Buying a home, retirement etc).

(2 Points) Withdrawal all your investment earnings and a some of your capital

(5 Points) Withdraw all your investment earnings without touching your capital

(10 Points) Withdraw only a portion of your investment earnings

(20 Points) Accumulate savings with your investment earnings (No withdrawals)

4. What is your gross annual income? (before taxes) *

5. What is your net worth? (assets minus liabilities) *

6. Which of the following statements would you feel most correctly describes your investment philosophy? *

(1 Point) Very Low - I do not like the idea of risking my money. My sole objective is to safely conserve my investments and shelter these amounts from market fluctuations. (If you choose this option, you may need re-evaluate your need for growth, and carefully consider it in light of your desire for stability. Portfolios with no ups and downs generally have no growth component. If you are sure you cannot tolerate any loss (even short term), consider using guaranteed investments or short-term options like money-market funds

(2 Points) Low - While a drop in the value of my investments bothers me, I can tolerate occasional drops to a maximum of 5% knowing that I will earn more investment earnings in the long run.

(5 Points) Medium - I am prepared to tolerate a short-term drop of between 5% to 10% of the value of my investments as long as I can count on higher investment earnings in the long term.

(10 Points) High - I am comfortable with a short-term drop of between 10% to 20% of the value of my investment because I know that in the long term, my investment earnings will allow me to make up for this drop and obtain higher earnings

(20 Points) Very High - I hope to achieve long-term growth. A short-term drop (less than 1 year) of 20% of the value of my investments does not worry me.

7. A portfolio is a basket of different investments. The returns earned by a specific portfolio depend on the mix of investments that make up the portfolio. The following graph shows the probable range of returns (from best to worst) of four hypothetical portfolios over a one-year period. In which of these portfolios would you prefer to invest? *

(1 Point) Portfolio A

(5 Points) Portfolio B

(10 Points) Portfolio C

(20 Points) Portfolio D

8. What is your level of knowledge about investments? *

(1 Point) Very Low - I am just starting to become familiar with investments

(2 Points) Low - I know that certain investments are riskier than others

(5 Points) Moderate - I know about different investment types and their risks

(10 Points) Advanced - I understand the earnings potential and risks involved

(20 Points) Very Advanced - I keep a constant eye on stock markets

REASON WHY WE ARE RECOMMENDING THIS STRATEGY

The applicant would like us to manage their portfolio to take advantage of the professional management offered by pooled investments while benefiting from the capital protection offered by the insurance company. To this end we have recommended the segregated fund and have explained the risks involved. The applicant has agreed that this route is one that fits their investment goals. We will invest the funds according to their investor profile.

ADVANTAGES OF WORKING WITH US

SIMPLICITY

With your advisor, you can determine which portfolio best suits your needs based on your investor profile.
You need not worry about choosing funds within the portfolio; these are selected by the portfolio manager based on the markets and their economic outlook.
Periodic review to maintain the allocation of your investment portfolio and in keeping with your risk tolerance.

EFFECTIVENESS

Growth with less volatility, thanks to a diversification of asset classes, managers, management style, geographies and economic sectors.
Access to multiple quality funds.
Expertise of renowned fund managers

ACKNOWLEDGEMENT
I hereby acknowledge that the above investment risk stance is consistent with my investment risk requirements and profile. Before making any investment decision, I will fully understand the product risks and features in order to determine that my investment decision is consistent with my investment objectives, risk-appetite and financial resources.

Client Signature *

Clear