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Enrolment form
January 1, 2010
I am enroling as a member in the following plan:
ABC Company - Registered Pension Plan
Policy: 11111111
Your personal information
Last name:
Jones
First name:
Terry
Middle initial:
A
Date of birth:
March 1, 1965
Gender:
Male
S.I.N.:
456-987-442
Marital status:
Married
Language:
English
Your investment style:
Growth
Customer number:
123456789
Your plan information
Date you started with your employer:
January 1, 1990
Date you are joining the plan:
December 31, 2003
Member number:
12345
Your address
Street number & name:
401 King Street. South
City:
Kitchener
Province/State:
ON
Country:
CANADA
Postal code/Zip:
N2J 2Y1
Telephone number:
(519) 747-7000
Email:
terry_jones@manulife.com
Your beneficiary information
I hearby designate the following as my beneficiary(s).
Beneficiary name
Relationship
%
Trustee name if a
minor beneficiary*
Melanie Jones
Spouse
100
* You must specify a trustee if your beneficiary is less than the age of majority.
Your Payroll Deductions
Contribution Type: Member Required
Pay Period
Contribution
Jan 16, 2011 - Jan 31, 2011
1.00%
Feb 01, 2011 - Feb 15, 2011
1.00%
Feb 16, 2011 - Feb 28, 2011
1.00%
Mar 01, 2011 - Mar 15, 2011
1.00%
Contribution Type: Member Voluntary
Pay Period
Contribution
Jan 16, 2011 - Jan 31, 2011
1.00%
Feb 01, 2011 - Feb 15, 2011
1.00%
Feb 16, 2011 - Feb 28, 2011
1.00%
Mar 01, 2011 - Mar 15, 2011
1.00%
I understand that the investment performance of amounts directed to a pooled or segregated fund is not guaranteed.
Your beneficiary(s) are deemed to be revocable.
Regarding Pension Plans and locked in funds only: Legislation in most jurisdictions may require any death benefit from a pension plan or locked-in pension funds to be payable to your spouse. If you are designating a beneficiary other than your spouse in these jurisdictions, the beneficiary may only be entitled to the death benefit if you do not have a spouse at the time of your death.
Your investment selection(s)
All contribution categories
Percentage
7171 - ML SEAMARK Canadian Equity k6
54%
7122 - ML MMF Growth Opportunities k7
16%
8191 - ML U.S. Equity a6
18%
8192 - ML International Equity k9
12%
I understand that the investment performance of amounts directed to a pooled or segregated fund is not guaranteed.
Authorization
I request that Manulife Financial enrol me as an annuitant (member) in the Plan and register me in a Retirement Savings Plan under the Income Tax Act (Canada) and (for Quebec registration only) a Retirement Savings Plan under and for the purpose of applicable regulations in respect to the Taxation Act (Quebec).
I understand that any benefit payments out of a Retirement Savings Plan will be taxable to the recipient to the extent prescribed by the Income Tax Act(Canada) or the Taxation Act (Quebec), whichever is applicable.
I hereby authorize the use of my Social Insurance Number for the purpose of tax reporting and for the identification and administration of any benefits, policies or contracts administered by Manulife Financial. contributions and to deliver directions or requests to Manulife Financial on my behalf.
If applicable, I hereby request that Manulife Financial accept the transfer of my locked-in pension funds into the Plan in accordance with the supplementary Locked-in Retirement account agreement or locking-in addendum. With respect to such funds, I understand that terms of the Locked-in Retirement Account agreement or locking-in addendum will override the terms of the Group Retirement Savings Plan contract, where applicable.
I understand that withdrawals may be restricted under the terms of the Plan.
I hereby certify that the information on this form is correct to the best of my knowledge.
Confidentiality
Manulife Financial is aware that confidentiality of personal information is important to our clients. At the same time, as a provider of financial services, the collection and use of personal information is fundamental to our business.
Any information provided with respect to this application, or information related to you or your investments which is in our possession while you are a plan member, will be maintained in a Canadian Pension Operations Client Services file. Access to personal information will be limited to:
Manulife Financial employees and representatives in the performance of their duties.
Those to whom you have granted access; and,
Those authorized by law.
The information you have provided is necessary and will allow Manulife Financial to evaluate your needs, help you choose one or more financial products corresponding to your financial objectives and administer your account. We may also use this information, form time to time, to provide you with details on other financial services and products available from Manulife Financial and other members of its group of companies that may be of interest to you.
You have the right to request access to personal information, and if necessary, make changes to ensure we have accurate information. To do so, please send a written request to:
Manulife Financial
Att: CPO Client Services
P.O. Box 396 STN Waterloo,
Waterloo ON N2J 4A9
Customer Satisfaction and Complaint Handling
Manulife Financial is committed to providing high quality service and products to assist Canadians in their financial planning. If customers have any questions or concerns about the products, services or representatives of the Company, Manulife wants to make sure that these concerns are handled fairly and efficiently.
Manulife has a simple complaint resolution process:
Please contact your advisor or CPO Client Services at 1-888-727-7766 about your concern. Most problems can be corrected quickly and easily by speaking with your advisor or with a Customer Service Representative.
If your concern isn't resolved to your satisfaction, please ask to speak with a senior manager in that business area. That person will give the matter a senior review and discuss your concerns.
To request additional consideration of your problem, please ask to speak with a member of the Client Relations department or the Complaint Handling Officer in that area.
If your complaint still isn't resolved to your satisfaction, under the Complaint Information Regulations that govern insurance, bank, trust and loan companies, you may choose to have it reviewed by the Financial Consumer Agency of Canada (FCAC). Manulife will co-operate fully in that external review. At the FCAC's request, complaints must be communicated in writing to:
