Beneficiary designations for Lifecheque policies

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					                                                           Beneficiary designations for Lifecheque policies
                                                           • Use this form to designate beneficiaries to receive benefits under your
Mail this completed form to                                  Lifecheque policy if the application for the policy was signed in Quebec or Manitoba and
Manulife Financial at:                                       you were a resident of Quebec or Manitoba when the policy was issued.
In Manitoba                                                  Do not use this form if the application for the policy was signed in any province or territory
Individual Insurance                                         except Quebec and Manitoba and you were a resident of any province or territory except
500 King Street North                                        Quebec and Manitoba when your policy was issued; instead, use Direction to pay for
PO BOX 1669                                                  Lifecheque policies, NN0999E.
WATERLOO, ON N2J 4Z6                                       • The information you provide in this form revokes all previous beneficiary designations for this
1-888-626-8543                                               insured person under the application or policy identified below. Any beneficiaries previously
                                                             designated as irrevocable beneficiaries must sign this form to consent to any change.
In Quebec
Individual Insurance                                       • We, us and our refer to The Manufacturers Life Insurance Company.
2000, rue Mansfield, bureau 1310                           • You and your refer to the policy owner.
MONTREAL QC H3A 3A1                                        If you have any questions about how to complete this form, contact your advisor or call our
1-888-626-8843                                             Customer Service Center.
                                           Name of insured person (first, middle initial, last)                                      Application or policy number
1 Application or policy
  information
                                           Name of policy owner (first, middle initial, last) or full legal name for a corporation
   Policy owner #1

                                           Address (number, street, apartment)



                                           City or town                                                                  Province    Postal code



                                           Name of policy owner (first, middle initial, last)
   Policy owner #2
   (if applicable)
                                           Address (number, street, apartment)



                                           City or town                                                                  Province    Postal code



2 How the beneficiary                      You can designate one or more beneficiaries and one or more secondary (subrogated in Quebec)
  designation will apply                   beneficiaries for each critical illness insurance coverage or rider coverage and for each LivingCare
                                           benefit that is in effect under this policy for this insured person.
                                           If you do not designate a beneficiary for each critical illness insurance or rider coverage in effect, any
                                           benefits from that coverage will be paid to the owner. If you do not designate a beneficiary for each
                                           LivingCare benefit in effect, any care benefits will be paid to the insured person.
                                           The secondary (subrogated in Quebec) beneficiary receives a benefit only if the beneficiaries
                                               • die before the insured person, or
                                               • are disqualified from receiving the benefit.
                                           If you designate more than one beneficiary, or more than one secondary (subrogated in Quebec)
                                           beneficiary, tell us the percentage share of the benefit that each person is to receive. If you don't
                                           specify the percentages, we will divide the benefit payable evenly.
                                           Information about irrevocable and revocable beneficiary designations
                                           For policies in Quebec only: If you designate your married or civil union spouse as a beneficiary, the
                                           designation is Irrevocable unless you write Revocable beside that beneficiary's name.
                                           For policies in Manitoba only: Any beneficiary you designate is Revocable. You cannot designate a
                                           beneficary as irrevocable.
                                           If you designate a beneficiary as Irrevocable your rights in the policy will be limited. The beneficiary
                                           must give written consent before you can:
                                               • change this designation;
                                               • withdraw funds;
                                               • assign the contract;
                                               • transfer ownership; or
                                               • otherwise change your policy (for example, decrease coverage).
                                           Minor children cannot give written consent to these changes. Parents or guardians/tutors cannot give
                                           consent on behalf of minor beneficiaries.
                                           If you designate a beneficiary as Revocable the beneficiary does not have to give written consent
                                           before you can make changes to the policy, including changing the beneficiary.



The Manufacturers Life Insurance Company                                          Page 1 of 4                                                      NN1467E (04/2009)
3 Designate beneficiaries                  Who is to receive any Covered Condition Benefit, Early Intervention Benefit, Age 100 Benefit and
  for critical illness                     Recovery Benefit payable for all the insurance coverages for this insured person on this policy?
                                           If you leave this section blank, we will pay the Covered Condition Benefit, Early Intervention Benefit,
  insurance coverages
                                           Age 100 Benefit and Recovery Benefit to the owner(s) or their estates, as applicable.
  * In Manitoba, tell us each              For policies in Quebec only: If you designate your married or civil union spouse as a beneficiary, the
    beneficiary’s relationship to the      designation is Irrevocable unless you write Revocable beside that beneficiary's name.
    insured person.                        For policies in Manitoba only: Any beneficiary you designate is Revocable. You cannot designate a
    In Quebec, tell us each                beneficary as irrevocable.
    beneficiary’s relationship to the
                                                                                                                                         Share of
    owner.                                 Name of beneficiary                                       Relationship*                       benefit**
 ** If you designate more than
    one beneficiary, or more than                                                                                                                    %
    one secondary (subrogated in
    Quebec) beneficiary, tell us the
    percentage share of the benefit
    that each person is to receive. If                                                                                                               %
    you don't specify the
    percentages, we will divide the
    benefit payable evenly.
                                                                                                                                                     %
*** The secondary (subrogated in
    Quebec) beneficiary receives a
    benefit only if the beneficiaries
    • die before the insured person,                                                                                                                 %
      or
    • are disqualified from receiving                                                                                                          100%
      the benefit.                                                                                                                       Share of
                                           Name of secondary (subrogated in Quebec) beneficiary***   Relationship*                       benefit**


                                                                                                                                                     %



                                                                                                                                                     %



                                                                                                                                                     %



                                                                                                                                                     %


                                                                                                                                               100%




The Manufacturers Life Insurance Company                                   Page 2 of 4                                           NN1467E (04/2009)
4 Designate beneficiaries                  Who is to receive any benefits payable from the ROP rider(s) for this insured person on this policy?
  for return of premium at                 If you leave this section blank, we will pay any ROP benefits to the owner(s) or their estates, as applicable.
  expiry rider and return of               For policies in Quebec only: If you designate your married or civil union spouse as a beneficiary, the
  premium with early                       designation is Irrevocable unless you write Revocable beside that beneficiary's name.
  surrender option rider                   For policies in Manitoba only: Any beneficiary you designate is Revocable. You cannot designate a
  (ROP riders)                             beneficary as irrevocable.
                                                                                                                                              Share of
                                           Name of beneficiary                                        Relationship*
  * In Manitoba, tell us each                                                                                                                 benefit**
    beneficiary’s relationship to the
    insured person.                                                                                                                                       %
    In Quebec, tell us each
    beneficiary’s relationship to the
    owner.                                                                                                                                                %
 ** If you designate more than
    one beneficiary, or more than
    one secondary (subrogated in                                                                                                                          %
    Quebec) beneficiary, tell us the
    percentage share of the benefit
    that each person is to receive. If                                                                                                                    %
    you don't specify the
    percentages, we will divide the                                                                                                                 100%
    benefit payable evenly.                                                                                                                   Share of
                                           Name of secondary (subrogated in Quebec) beneficiary***    Relationship*                           benefit**
*** The secondary (subrogated in
    Quebec) beneficiary receives a
                                                                                                                                                          %
    benefit only if the beneficiaries
    • die before the insured person,
      or
    • are disqualified from receiving                                                                                                                     %
      the benefit.
                                                                                                                                                          %



                                                                                                                                                          %

                                                                                                                                                    100%

5 Designate beneficiaries                  Who is to receive any benefits payable from the ROPD rider(s) for this insured person on this policy?
  for return of premium on                 If you leave this section blank, we will pay any ROPD benefits to the owner(s) or their estates, as applicable.
  death rider (ROPD rider)                 For policies in Quebec only: If you designate your married or civil union spouse as a beneficiary, the
                                           designation is Irrevocable unless you write Revocable beside that beneficiary's name.
  * In Manitoba, tell us each              For policies in Manitoba only: Any beneficiary you designate is Revocable. You cannot designate a
    beneficiary’s relationship to the      beneficary as irrevocable.
    insured person.                                                                                                                           Share of
    In Quebec, tell us each                Name of beneficiary                                        Relationship*                           benefit**
    beneficiary’s relationship to the
    owner.                                                                                                                                                %
 ** If you designate more than
    one beneficiary, or more than
    one secondary (subrogated in                                                                                                                          %
    Quebec) beneficiary, tell us the
    percentage share of the benefit
    that each person is to receive. If                                                                                                                    %
    you don't specify the
    percentages, we will divide the
    benefit payable evenly.                                                                                                                               %
*** The secondary (subrogated in
    Quebec) beneficiary receives a                                                                                                                  100%
    benefit only if the beneficiaries                                                                 Relationship*                           Share of
                                           Name of secondary (subrogated in Quebec) beneficiary***                                            benefit**
    • die before the insured person,
      or
    • are disqualified from receiving                                                                                                                     %
      the benefit.

                                                                                                                                                          %



                                                                                                                                                          %



                                                                                                                                                          %

                                                                                                                                                    100%

The Manufacturers Life Insurance Company                                   Page 3 of 4                                                NN1467E (04/2009)
6 Designate beneficiaries                  Who is to receive any care benefits payable from the LivingCare benefit(s) for this insured person on
  for the LivingCare benefit               this policy?
                                           If you leave this section blank, we will pay the care benefits to the insured person identified in section 1.
  * In Manitoba, tell us each              For policies in Quebec only: If you designate your married or civil union spouse as a beneficiary, the
    beneficiary’s relationship to the      designation is Irrevocable unless you write Revocable beside that beneficiary's name.
    insured person.                        For policies in Manitoba only: Any beneficiary you designate is Revocable. You cannot designate a
    In Quebec, tell us each                beneficary as irrevocable.
    beneficiary’s relationship to the
                                                                                                                                               Share of
    owner.                                 Name of beneficiary                                                Relationship*                    benefit**
 ** If you designate more than
    one beneficiary, or more than                                                                                                                          %
    one secondary (subrogated in
    Quebec) beneficiary, tell us the
    percentage share of the benefit
    that each person is to receive. If                                                                                                                     %
    you don't specify the
    percentages, we will divide the
    benefit payable evenly.
                                                                                                                                                           %
*** The secondary (subrogated in
    Quebec) beneficiary receives a
    benefit only if the beneficiaries
    • die before the insured person,                                                                                                                       %
      or
    • are disqualified from receiving                                                                                                                100%
      the benefit.                                                                                                                             Share of
                                           Name of secondary (subrogated in Quebec) beneficiary***            Relationship*                    benefit**


                                                                                                                                                           %



                                                                                                                                                           %



                                                                                                                                                           %



                                                                                                                                                           %


                                                                                                                                                     100%

7 Signatures                               By signing below
                                           • you understand that if your policy is governed by Manitoba law, this beneficiary designation form will
   If the owner is a                         change your policy to confirm your right to designate one or more beneficiaries to receive the
   corporation, we require:                  benefits payable under your Lifecheque policy
   • the signatures and titles of          • you revoke all previous beneficiary designations for benefits from all coverages for the insured
      two signing officers or                person on this application or policy and, if applicable, all benefits payable under riders and
   • the signature and title of one          LivingCare benefits associated with those coverages, and
      signing officer and the              • you direct that any benefits payable will be paid to the beneficiary or beneficiaries designated on this
      corporate seal;                        form.
      If the corporation does not          Signed at (city or town, province)
      have a corporate seal and
      you are the only person
      authorized to sign on behalf         Signature of policy owner #1                              Signature of witness             Date (dd/mmm/yyyy)
      of the corporation, sign in the
                                           ✘
      signature box for policy
      owner #1 and write your              Title (if applicable):                                    ✘
      initials in the box provided.        Signature of policy owner #2                              Signature of witness             Date (dd/mmm/yyyy)

                                           ✘                                                         ✘
                                           Title (if applicable):
                                           Initial here
                                                          Write your initials here to confirm that you are the only person authorized to sign on behalf
                                                          of the corporation and that it does not have a seal. You must also sign above.
   For changes to irrevocable
   beneficiary designations                By signing below, you consent to any changes in the beneficiary designation(s) for the policy described
                                           on the form, even if those changes negatively affect your interests as a beneficiary.
                                           Signature of irrevocable beneficiary                      Signature of witness             Date (dd/mmm/yyyy)


                                           ✘                                                         ✘

The Manufacturers Life Insurance Company                                          Page 4 of 4                                           NN1467E (04/2009)

				
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