Beneficiary Designation _with Contingent Beneficiaries_ - 1

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Beneficiary Designation _with Contingent Beneficiaries_ - 1 Powered By Docstoc
					                                                                      Registered Plans
     Reset Form                        Print Form                     Beneficiary Designation                                               (with Contingent Beneficiaries)



                                                                      Please note: Phillips, Hager & North will accept only one Beneficiary
     New Account     or        Change to Existing Account             Designation form (contingent or other) per account.
 1      Account Information
 Annuitant’s name (first, middle, last)                                                  Account number                                                    Social Insurance Number

                                                                                                                                                                I    I    I     I    I   I   I    I
Please indicate the account type:
     Retirement Savings Plan        Spousal Retirement Savings Plan     Locked-in Retirement Savings Plan                       Locked-in Retirement Account                   Restricted Life Income Fund
     Retirement Income Fund         Spousal Retirement Income Fund      Locked-in Retirement Income Fund                        Life Income Fund                               Restricted Locked-in
     Prescribed Retirement                                                                                                                                                     Savings Plan
     Income Fund

 2      Beneficiary Designation               I hereby designate the person listed below to receive the assets of my Plan upon my death.
Check one box only
  Beneficiary or          Successor Annuitant Election Applicable for RRIF, LIF, LRIF, RLIF, PRIF Plans Only:
                          If the person identified below is my spouse or common law partner, I elect to have my spouse or common law partner continue to receive all Fund
                          payments after my death. If my successor annuitant survives me, I acknowledge that I cannot designate another beneficiary under the Fund.

 Name (first, middle, last)                                                                                  Relationship to you


 Mailing address                                                                      Telephone number                                                                                           Email


 City or town                                Province        Postal code              Social Insurance Number (if available)                               Date of Birth (yyyy/mm/dd) (if available)

                                                                                             I       I   I   I      I       I       I        I

 3      Contingent Beneficiary Designations                    If the person identified above predeceases me, I designate the person(s) identified below as the
                                                               beneficiary(s) of my Plan / Fund to receive their Percentage of Entitlement (as indicated below) of the
                                                               proceeds of the Plan / Fund on my death.
 A) Name (first, middle, last)                                                                                   Relationship to you                                          % of Plan assets designated
                                                                                                                                                                                                      %
 or Full legal name of charity (Trusts are not accepted)                                                                                                   Charity registration number


 Mailing address                                                                      Telephone number                                                     Email


 City or town                                Province         Postal code             Social Insurance Number (if available)                               Date of Birth (yyyy/mm/dd) (if available)

                                                                                         I       I       I   I          I       I       I        I
 B) Name (first, middle, last)                                                                                   Relationship to you                                          % of Plan assets designated
                                                                                                                                                                                                      %
 or Full legal name of charity (Trusts are not accepted)                                                                                                    Charity registration number


 Mailing address                                                                      Telephone number                                                     Email


 City or town                                Province         Postal code             Social Insurance Number (if available)                               Date of Birth (yyyy/mm/dd) (if available)

                                                                                         I       I       I   I          I       I       I        I
 C) Name (first, middle, last)                                                                                   Relationship to you                                          % of Plan assets designated
                                                                                                                                                                                                      %
 or Full legal name of charity (Trusts are not accepted)                                                                                                   Charity registration number


 Mailing address                                                                      Telephone number                                                     Email


 City or town                                Province         Postal code             Social Insurance Number (if available)                               Date of Birth (yyyy/mm/dd) (if available)

                                                                                         I       I       I   I          I       I       I        I

 4      Signature          By signing here, I confirm that I have read and agree to the Conditions on the reverse.
 Account holder’s signature                                                         Province or Territory of Execution                                     Date (yyyy/mm/dd)



  FOR PH&N USE ONLY
     PH&NIM Client Services representative as agent for The Royal Trust Company                                                     Number                 Date (yyyy/mm/dd)
1. CONDITIONS
Note to Annuitants Domiciled in Quebec: A beneficiary designation                                             I declare that any property passing to a beneficiary from the Plan / Fund,
made directly on the Plan / Fund is only accepted on locked-in plans.                                         the value of such property, and any and all income or capital gain or other
All capitalized terms shall have the meanings given to them in the                                            benefit arising from such property, shall remain the exclusive property of a
Declaration of Trust forming part of the retirement savings plan or                                           beneficiary and shall be excluded from a beneficiary’s net family property
retirement income fund as applicable.                                                                         or community of property or the value of a beneficiary’s assets for the
                                                                                                              purpose of division of property on a beneficiary’s separation, divorce,
By signing the front of this form I confirm that I understand and agree to the
                                                                                                              annulment or death as contemplated by any statute dealing with matrimonial
following Conditions:
                                                                                                              or family property in any jurisdiction to the extent allowed by law.
In accordance with the declaration of trust under the identified retirement
                                                                                                              I have expressly requested that this document be drawn up in the English
savings plan (the “Plan”) or retirement income fund (the “Fund”), I hereby
                                                                                                              language only./ J’ai expressément demandé que ce document soit rédigé en
revoke all previous beneficiary designations made in respect of the Plan
                                                                                                              langue anglaise seulement.
/ Fund, including any such designation made in my will, and I designate
the person identified as the Plan / Fund beneficiary entitled to receive all                                  •  eneficiary means the person validly designated by you to receive any
                                                                                                                B
amounts payable under the Plan / Fund upon my death.                                                            death benefit payable from the Plan/Fund on your death.
If no Percentage of Entitlement is stated (or the Percentages of Entitlement                                  • Contingent Beneficiary means the person validly designated by you to
do not add up to 100%), I direct that the proceeds of my Plan / Fund                                            receive a death benefit payable from the Plan on your death, contingent
be divided equally among the surviving beneficiary(ies) or paid to the                                          upon the applicable Beneficiary, who would have otherwise received the
surviving beneficiary on my death, as the case may be. If any person                                            death benefit, failing to survive you for at least 10 days.
identified predeceases me, I direct that their Percentage of Entitlement (as                                  •  pouse and common-law partner have the meanings defined in the
                                                                                                                S
indicated) be divided equally among the surviving beneficiary(ies) or paid                                      Income Tax Act (Canada).
to the surviving beneficiary on my death as the case may be. For greater
certainty, the share of a deceased beneficiary will go in equal portions to                                   •  uccessorannuitant means your spouse or common-law partner validly
                                                                                                                S
the surviving beneficiaries. If none of the person(s) identified survive me, I                                  designated by you to continue to receive payments from the Fund after
direct that the proceeds of my Plan / Fund be paid to my estate on my death.                                    your death.

This beneficiary designation will apply to all property held under the Plan /
Fund on my death.
In certain provinces or territories, a beneficiary designation, or any
revocation thereof, can only be made by will. In some cases, the rights
of my spouse or partner as may be defined under applicable provincial
law may override any such beneficiary designation. Also, a beneficiary
designation will not automatically change as a result of a future relationship
or relationship breakdown; it may be necessary to designate a new
beneficiary for this purpose.
I am solely responsible for ensuring that this beneficiary designation is
valid under the laws of Canada, its provinces or territories and that this
designation is changed when appropriate. If I am domiciled in Canada when
I die, I acknowledge that this beneficiary designation will be governed by
the laws of my province or territory of domicile at the time of my death.
If I am not domiciled in Canada at the time of my death, then the laws of
the province or territory where I was domiciled at the time of execution of
this form will apply, provided that was in Canada. Otherwise, the laws of
Ontario will apply.




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Please return form to: Phillips, Hager & North, 20th Floor, 200 Burrard Street, Vancouver, B.C., V6C 3N5
n Contact Us Investment Funds Centre: 1-800-661-6141 Facsimile: 1-800-666-9899 Email: info@phn.com Website: www.phn.com
                                                                                                                                 Beneficiary Designation (with Contingent Beneficiaries) 5.3G [ver 9] Nov 2010

				
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