SEGREGATED FUND TRADE TICKET FOR FILING PURPOSES ONLY. DO NOT DUPLICATE.

New Client Redemption RED/PUR Conversion

Dealer: 3057
Existing Client Switch Transfer
Purchase
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

First Name Last Name Date of Birth Social Insurance Number

Joint Applicant First Name Joint Applicant Last Name Date of Birth Social Insurance Number

Street Address RESP/RDSP/In Trust for/Beneficiary ITF

City-Town Province Date of Birth Social Insurance Number

Corp.
Postal Code Tel. (Residence) Tel. (Business)

SECTION 4 | TRADING INSTRUCTIONS Amount (Amt Type) 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 Gross/Net Wire Order #

Fund Name Account # Fund Name Account #

Fund Name Account # Fund Name Account #

Fund Name Account # Fund Name Account #

Fund Name Account # Fund Name Account #

Transactions processed by fund code only.

SECTION 5 | FEE DISCLOSURE For purchase, provide DSC/LL Schedule percentage %

For Redemptions, provide amount: $ Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7

SECTION 6 | REDEMPTION INSTRUCTIONS Make cheque payable to:

Client Deposit to bank account as per new void cheque Deposit to bank account as per existing void cheque
Forward to Client as per mailing address on file WFGIA-(ITF) forward via ICS to: 6700 Pierre-Bertrand Blvd., Suite 300, Québec (Québec) G2J 0B4

SECTION 7 | SPECIAL INSTRUCTIONS

SECTION 8 | CLIENT ACKNOWLEDGEMENT AND CONSENT

Did you borrow funds to purchase this investment? Yes No If Yes, did you review the disclosure document on the back of this Trade Ticket? Yes No
Have you been advised of, and are you comfortable with, all risks associated with leveraged investing? Yes No
I have received, read and understood 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.
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 therein. Your consent, relating to the use of your personal information
to provide you with details about other insurance and financial service 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. Attn: Privacy Officer, 5000 Yonge Street, Suite 800, Toronto, ON M2N 7E9

Client Signature Joint Client Signature (if applicable) Signed in the Province of (Required) Client Date

SECTION 9 | 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
Agent Initials (required)

Writing Agent - Print Name Writing Agent Signature Agent # Agent % Agent Date

Split Agent - Print Name Split Agent Signature Split Agent # Split Agent %

Cheques must be payable to World Financial Group Insurance Agency of Canada Inc. In Trust and not directly to an agent.
Original - WFG Dealer Connect 2nd Copy - Agent File 3rd Copy - Client
© 2018-2021 Transamerica Corporation WFGCA10083/8.21
 DISCLOSURES AND STATEMENTS
All the details of the contract benefits and provisions that you should know about this segregated fund contract are contained in the Information Folder and the Policy Contract. Please refer to
them and review any questions you have with your agent.
Please note that the value of your contract can go up or down subject to the guarantees. Any withdrawals you make will reduce your guarantees. For full details please refer to the appropriate
section of the Insurer’s Information Folder and the segregated funds contract. Also, note that the contract maturity date establishes when the contract guarantees come into effect.
Segregated funds are investment products. The performance of the investment options available in segregated funds is not guaranteed. You should carefully consider your tolerance for risk
when you select an investment option. Other critical factors to consider are your investment time horizon; your investment knowledge and your investment objective.

POINT OF SALE DISCLOSURE Your tax rate is fairly high

At the time you enter into a segregated fund contract, you must be presented with key Borrowing money to purchase a segregated fund is particularly suitable for investors
documents. with fairly high tax rates because the interest payable on the loan may be tax deductible.
• The Information Folder must be delivered to you before you sign the application for However, borrowing is not necessarily a good strategy based solely on tax benefits. You
the segregated fund. The Information Folder must contain a Key Facts document that should not consider just this criterion when deciding whether or not to use leveraging.
briefly describes the key features of the contract. You are in a healthy financial position
• You may choose to receive these disclosure documents either physically (in person, by You should be able to repay the loan in addition to the interest stipulated in the loan
mail, or by fax) or electronically (e-mail or viewed online). You must sign acknowledging agreement. Generally, a loan for the purchase of an investment should not exceed
receipt of these documents. 30% of your net worth and 50% of your net liquid assets. For example, if your net
• You need to be aware that the insurer must offer a two-day rescission right (i.e., free liquid assets total $200,000, you should not take out a loan for more than $100,000.
exit) that applies to the decision to enter into the contract and/or any fund selection. You have the required knowledge
You should be aware of the risks associated with borrowing for investment purposes.
COMPENSATION DISCLOSURE STATEMENT When you use leveraging, the value of the securities purchased could decline and be
World Financial Group Insurance Agency of Canada Inc. (WFGIA), in performing our lower than the value of the loan. You may be required to incur losses according to the terms
services on your behalf, may be eligible to receive compensation from one or more of the loan. Furthermore, if you rely on the return generated by the securities you have
sources. Your agent can give you a complete explanation of the compensation he or she purchased to cover the payments on the loan you may become unable to repay the loan.
will receive if you buy insurance products, such as segregated funds.
Once you have taken out a loan:
TERMS AND CONDITIONS Notify your representative if your financial position changes. For example, divorce,
A withdrawal from one fund and a deposit to another will result in the funds being out loss of employment or retirement are events that should prompt you to review the
of the market for at least one valuation day. Unit values fluctuate daily and there is a suitability of leveraging. Monitor interest rates because when they rise the cost of
risk of being out the market during a unit value change. borrowing usually increases.
• The withdrawal transaction could negatively affect the value of the contract’s Death The drawbacks of borrowing for investment purposes:
Benefit Guarantee. The return on your investments may be lower than the borrowing rate (after income
• The withdrawal transactions could negatively affect the value of the contract’s tax is taken into consideration) and your investments may lose value and your
Maturity Guarantee. financial institution may demand repayment of the loan. Remember:
• The withdrawal may result in a capital gain or a capital loss since it creates a • You will need to repay the loan in full
taxable disposition (non-registered contracts only). • You will need to pay all accumulated interest
• You may be charged deferred sales charges for the withdrawal portion of this transaction.
FILING A COMPLAINT
• Movement between sales charge options must be within the same guarantee class.
A market conduct complaint is any complaint that brings into question the actions of
• You have the right to change your mind within two business days of either the date agents in regards to his/her conduct in connection with the sale, sales development or
you received confirmation or five business days after it is mailed. With written service of WFGIA-approved insurance products. It is an expression of dissatisfaction
notification, we will refund the lesser of the value of your deposit or the market against the insurer or your agent with the identification of real or potential harm that
value of the day we receive your request. Fees and charges will be refunded. you have experienced, or may experience, and your request for remedial action.
RESPONSIBILITY For more information on how to file a complaint, contact the Compliance Department
of the insurance company that issued the contract or the Compliance Department at
You will not hold WFGIA liable for any loss or any failure to obtain any profit that is
World Financial Group Insurance Agency of Canada Inc.
caused directly or indirectly by government restrictions; exchange or market rulings;
suspension of trading; unavailability of any Electronic Service to allow for maintenance, PERSONAL INFORMATION
updates or other reasonable cause; wars, strikes or other conditions beyond its control;
WFGIA is committed to protecting the privacy of all personal client information that
or any errors or omissions in connection with or in the handling of orders relating to the
is being collected, used and disclosed in the course of carrying out business with you.
purchase, sale, execution, or expiration of any trades or any related matter, unless WFGIA
Upon receipt of this application, WFGIA will establish a file in which will be placed personal
was grossly negligent. WFGIA will not act on any verbal instructions. To process a
information about you concerning (a) this application; (b) any other form, application,
purchase, switch, sale or any other transaction, written instructions are required. WFGIA
authorization, trade ticket or other document you complete in relation to this application
hereby guarantees repayment of any monetary loss that is incurred by the applicant
or to your investment account with us; and (c) other documents or information relating to
as the result of a sale of segregated fund shares or units contemplated by this client
the servicing and administration of this application or your investment account with us. We
application form, provided such loss is directly attributable to fraud, theft or negligence
collect personal information about you from this application and any supplementary forms,
on the part of WFGIA or an employee thereof.
as well as from our agents. We collect and use your personal information for the purposes
BORROWING MONEY FOR INVESTMENT PURPOSES of assessing and implementing your investment objectives and instructions, providing you
with investment advice, servicing and administering this application and your investment
Leveraging consists of borrowing money for investment purposes. This allows you to
account with us, and for such other purposes as are outlined in this application. Your
make a larger investment than if you only draw on your own savings. For the purposes of
information may be disclosed to your agent for the purposes identified above. Your Social
this information sheet, assume that leveraging involves borrowing at least $15,000 for
Insurance Number will be used for income reporting purposes.
an investment and repaying the loan over several years. Borrowing to invest can involve
significant risk. Your banking information will be disclosed to the financial institution(s) processing
your investment deposits and withdrawals. You represent and warrant that you are
Before you use leveraging:
authorized to provide the personal information of a referring third party as requested
1. Read the documentation received on the risks of this strategy. in this application.
2. Determine your tolerance for risk. Make sure you have fully understood and evaluated From time to time WFGIA may use your personal information to determine what
the risks of borrowing to invest and that this strategy fits into your risk profile. other financial or insurance products and services may meet your needs and offer
3. Make sure that your investment horizon is long enough (5 years minimum). them to you. Your consent for this use of your personal information is optional. If you
4. Make sure you fully understand the tax impact of this strategy. do not wish your personal information to be used for this optional purpose, please
5. Borrow only what you can repay without having to sell your investment. Do not borrow make the appropriate selection on the front of this form.
more than you can repay. Employees or authorized agents of WFGIA who will be responsible for functions relevant
6. Know exactly how much money you would lose in a worse-case scenario. For example, to the purposes identified above, and other persons authorized by you or by law, will have
would you be able to handle a 30% decline in the value of your investments? access to the personal information contained in your file. Subject to exceptions set out in
applicable legislation, you may access your file and request corrections to your personal
You have a medium to high tolerance for risk information by sending a written request to World Financial Group Insurance Agency of
You should be comfortable with the risk of borrowing for investment purposes. This Canada Inc. Attn: Privacy Officer, 5000 Yonge Street, Suite 800, Toronto, ON M2N 7E9.
strategy is not appropriate for conservative investors, whose profiles call for investments
with a low level of risk. This strategy is more suitable for investors with long-term By completing and signing this application, you acknowledge and agree that you
investment horizons (5 to 10 years). It is not suitable for older investors or those have provided personal and financial information that is true and accurate, and
approaching retirement who seek to maximize income and preserve capital. you consent to the collection, use and disclosure of your personal information as
described herein or at the time of collection, and as required or permitted by law.

If you have any questions concerning the processing of your transaction, please direct inquiries to:
World Financial Group Insurance Agency of Canada Inc., Operations Support | 5000 Yonge Street, Suite 800, Toronto, ON, M2N 7E9 Tel: 416-225-2121

© 2018-2021 Transamerica Corporation WFGCA10083/8.21