F15 Coverage - Repsource - Manulife Financial

Notice of Change of Insurer
Thank you for applying for insurance with us.
We are pleased to inform you that, on December 29, 2004, after receiving regulatory approval,
The Maritime Life Assurance Company (Maritime Life) merged its business and operations with
The Manufacturers Life Insurance Company (Manulife Financial). As a result, Manulife Financial has
assumed all the duties, obligations and liabilities of Maritime Life’s insurance business.
You have applied for insurance using a Maritime Life application form. If we issue an insurance contract
in connection with this application, it will be insured by Manulife Financial. We will ask you to sign an
Application Supplement when you receive the contract to confirm that you agree to this.
When you receive your insurance contract, it will contain references to Maritime Life; however this does
not change the fact that it is insured by Manulife Financial. Please rest assured that you will retain all the
benefits under this policy that you would have had if it had been issued by Maritime Life.
We are proud of our company, our mutual traditions, our history and the trust that millions of clients
around the world have placed in us. We look forward to building upon the trust you have placed in
Maritime Life as we come together to build the new Manulife Financial.
Sincerely,
Paul Rooney
Executive Vice President, Individual Insurance
The Manufacturers Life Insurance Company

Life Products
F15 Coverage
THE MARITIME LIFE ASSURANCE COMPANY
LIFE INSURANCE

At Maritime Life we believe a solid financial plan
is built one step at a time. So, we designed our
F15 policy to be that first important step.
Guaranteed for Life
Affordable, long-term protection is one of the highlights of F15 with all premiums and benefits fully guaranteed for
the life of your child’s policy.
Limited Premium Paying Period
With F15, premiums are guaranteed to be payable for only 15 years.
Premium Refund Option
We’ve designed this option to provide you or your child with loan collateral or emergency cash.
Here’s how it works:
If, after 20 years, your child no longer needs the insurance protection provided by F15, at least 100% of the basic
premiums* will be refunded. Beyond year 20, the cash value increases in 5 year intervals reaching 200% of the basic
premiums* after year 40. Beyond the later of year 45 and the life insured’s 50th birthday, the cash value will increase
even further.
* Excludes policy fee, modal extras, medical or other underwriting extras, and rider premiums.
% Refunded
Premiums Paid to Date
700%
350%
This graph illustrates the premium refund 0ption
for a 5 year old male, values shown assume
non-smoker status for life. Values beyond
year 45 differ for each issue age.
5 10
15
20
25
30
35
40
45 50 55 60 65
Policy Duration

Automatic Coverage Increases
Your child’s coverage will remain level until the later of age 25 or the end of the premium paying period. At this
time, coverage will automatically increase to 250% of the original amount if your child qualifies as a non-smoker
and 150% otherwise.
Coverage Continuation
If, for any reason, you are unable to pay premiums, your F15 policy will provide your child with two years of
extended term coverage for each full annual premium (or modal equivalent) paid.
Waiver of Premium on Death or Disability (WDDP)
If the payor is 50 or under at policy issue, this feature is automatically included with the purchase of an F15 policy,
subject to underwriting. It provides the payor with the assurance that if he/she becomes disabled or dies before the
end of the premium paying period, the policy will remain intact with premiums waived.
Your independent financial advisor can provide
you with a personalized illustration highlighting
how F15 can work for you.
F15 is designed with flexible options to meet
your child’s financial needs as they change over
the years.

Life Products
Marketing F15
THE MARITIME LIFE ASSURANCE COMPANY
Plan Setup and Administration
Issue Ages
Ages 0 to 18
Issue Limits
Minimums: Minimum coverage is $15,000.
Maximums: Greater of $5,000 annual premium or
modal equivalent and $500,000 initial coverage.
Policy Fee
$50 for primary policy
$25 for each additional policy
Premium Payment Frequency
• Annually
• Semi-annually
• Quarterly
• Monthly (ACS*, Pay Assignment*, Regular Billing)
* Canadian currency only
Coverage Continuation
If, for any reason, the client is unable to pay
premiums, the F15 policy will provide two years of
extended term coverage for each full annual premium
(or modal equivalent) paid, provided no loan is
outstanding. If all 15 premiums are paid, coverage is
guaranteed for life.
Tips for Illustrations
Customer Signature
One purpose of the sales illustration is to promote
customer understanding of the product they are
purchasing. It is clear the better the customer
understands their purchase, the more satisfying the
relationship will be for all of us. Obtaining the
customer’s signature on the illustration is
confirmation the customer has reviewed and
understands the information upon which their
purchasing decision is based.
Compliance Checklist
We have included a compliance checklist in the F15
software. At present, disclosure of the items identified
in the checklist is only mandatory to customers in
Ontario. We hope you will take their lead and review
the checklist with your customers. We are sure it will
prove extremely beneficial for your customers as well
as give you added documentation for your records.
Non-registered Investment
F15, along with a non-registered investment, can be
used as an alternative to an RESP. We have included
the ability to illustrate this arrangement in the F15
software.
To be detached and given to the client if applicable.
TEMPORARY LIFE INSURANCE
Temporary Life Insurance commences on the date of this agreement and is payable to the beneficiary(ies) named in the application, upon death of any Proposed Life Insured. The Maritime Life
Assurance Company agrees to provide temporary life insurance on any Proposed Life Insured, subject to the conditions of the agreement. It is acknowledged that the sum of
$ __________________ (one total monthly premium or 1/10th of the annual premium, as required) was paid to The Maritime Life Assurance Company at the time of completion of this agreement.
Life Insured’s Name __________________________________________________________________ Payor’s Name ______________________________________________________________
Advisor’s Signature ___________________________________________________________________ Date ______________________________________________________________________
Signed at ___________________________________________________________________________ Province __________________________________________________________________

F15 Rates
Per $1000 of coverage
Age M Age F Rate
0 0-2 6.70
1 3 6.79
2 4 6.90
3 5 7.06
4 6 7.23
5 7 7.41
6 8 7.71
7 9 8.07
8 10 8.49
9 11 8.88
10 12 9.28
11 13 9.70
12 14 10.13
13 15 10.57
14 16 11.02
15 17 11.51
16 18 11.83
17 12.06
18 12.29
Modal Factors
Frequency Sask & NS NFLD PEI Quebec
Other
Provinces
Annual 1.010 1.020 1.015 1.004 1.000
Semi-annual .530 .535 .533 .527 .525
Quarterly .271 .273 .272 .269 .268
Monthly .091 .092 .091 .090 .090
Minimums
Minimum coverage is $15,000.
Maximums
Greater of $5,000 annual premium or modal equivalent
and $500,000 initial coverage.
Cash Values
F15 accrues cash value according to the following
schedule, less fees, modal extras, rider premiums
and medical extras.
Benefit Year
Percent Refunded
1 5%
2 10%
3 15%
4 20%
5 25%
6 30%
7 35%
8 40%
9 45%
10 50%
11 55%
12 60%
13 65%
14 70%
15 75%
16 80%
17 85%
18 90%
19 95%
20 100%
21-25 100%
26-30 125%
31-35 150%
No Cash Value is available after the Extended
Term Provision has been continuously in effect
for more than five years.
Please add a $50 policy fee. A reduced fee of $25
applies when F15 is purchased in addition to another
Maritime Life insurance plan (e.g. Intrepid II, Term Life
Series, Architect Summit II).
TEMPORARY LIFE INSURANCE AGREEMENT/CONDITIONS
Amount: The amount of Temporary Life Insurance provided under this agreement is the total of the amounts provided for in this application and any other temporary life insurance agreement
with The Maritime Life Assurance Company subject to a maximum amount of $200,000 on each life.
Benefits: No insurance is provided for under any accidental death or disability benefit.
Insurability: Questions 8, 9 and 10 must all have been correctly answered NO for a proposed life to be insured.
Age Limitation: The age of the Life Insured must not exceed 18 years as of their last birthday.
Misrepresentation, Non-Disclosure or Self Destruction: The Maritime Life Assurance Company declares this Agreement to be null and void if any Proposed Life Insured dies by his or her own
act, whether sane or insane or if any of the answers or details pertaining to this Agreement or the application are false. Any payment made with this Agreement will be refunded to the Owner.
Premium Payment: Post dated cheques are not acceptable. One monthly premium or one-tenth of the annual premiums must be collected with the application.
Modification: No representative of The Maritime Life Assurance Company has the authority to modify this Temporary Life Insurance Agreement in any way.
Termination: Insurance coverage provided by this Agreement will terminate automatically on the date the insurance applied for becomes effective or ninety days from the date this receipt was
signed, whichever is earlier. The Maritime Life Assurance Company may terminate this Agreement by mailing a notice to that effect addressed to the Owner, in which event any money paid will
be refunded. Termination will be effective at midnight of the mailing date. Termination will be effective the date and time of the application whenever any payment of the initial premium is
not honored.

F15 Application for Insurance
(Please Print)
1. Life Insured
Name: ____________________________________________________________________________________________________________________ ! Male ! Female
First Initial Last
Date of Birth: ________________________ at __________________________________________________________________________________________________________________________
DD / MM / YY Country
Address: _________________________________________________________________________________________________________________________________________________________
Street City Province Postal Code
Occupation (if applicable): _____________________________________________________________________________
2. Beneficiary
Name: _______________________________________________________________________________________________
Name of Trustee: ______________________________________________________________________________________
(If Beneficiary is a Minor)
Quebec Cases Only: Irrevocable: ! Yes ! No
3. Owner (Applicant)
Annual Income: ___________________________________________
Relationship:______________________________________________
Relationship:______________________________________________
Name: ____________________________________________________________________________________________________________________ Date of Birth:_________________________
First Initial Last DD / MM / YY
Address: _________________________________________________________________________________________________________________________________________________________
Street City Province Postal Code
Phone: ____________________________________________________
Relationship to Insured: _______________________________________________________________________________
Occupation: __________________________________________________________________________________________
Annual Income: ___________________________________________
Contingent Owner: ________________________________________________________________________________________________________________________________________________
4. Existing or Pending Coverage on Life Insured: $ __________________________________
Company: ____________________________________________________________________________________________
Year of Issue: ______________________________________________
Amount on Other Children: $ ________________________________________________________________________________________________________________________________________
Total Amount on Applicant: $________________________________________________________________________________________________________________________________________
Is this insurance intended to replace or change existing coverage: ! Yes ! No
If Yes, Company? __________________________________________________________________________________________________________________________________________________
(Please complete replacement form and include with this application)
Amount of F15 applied for:
Amount $ __________________________________________________ Annual Premium $ ______________________________________________ Modal Premium $_______________________
Payment Frequency: ! Annual ! Semi-Annual ! Quarterly ! Monthly
! ACS ! Other ________________________
Is this policy to be billed with any other policy with this Company: ! Yes ! No
If so, policy number(s)______________________________________________________________________________________________________________________________________________
*Payor ___________________________________________________________________________________________________________________________________________________________
Name Address Date of Birth
*Note: Waiver on death or disability applies to payor. To qualify, the payor must be age 50 or below. Maiden Name of Payor (if applicable) _________________________________________
AUTHORIZED CHEQUING SERVICE (ACS) Where the monthly payment frequency has been chosen, I/We authorize The Maritime Life Assurance Company to make Pre-Authorized Cheque
Withdrawals from the payor’s bank account for the purpose of paying the premiums as due. If premiums change for the insurance policy issued from this Application, I/We authorize The
Maritime Life Assurance Company to amend the amount of the automatic withdrawals. This payment method may be cancelled by providing 10 days’ written notice to the Head Office of The
Maritime Life Assurance Company.
_______________________________________________________________ ____________________ __________________________________________________ ___________________
Owner’s Signature Date Payor’s Signature Date
Type of Account ____________________________________________________________________________________________________________________________________________________
(attach an encoded cheque sample marked “VOID”)
Name of Financial Institution, Transit No. and Branch Address: ____________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________
Special Withdrawal date, if required: ___________________________________________________________________________________________________________________________________
AUTHORIZATION TO RELEASE INFORMATION
I/We hereby authorize any licensed physician, medical practitioner, hospital, clinic or other medical or medically related facility, insurance company, the Medical Information Bureau, or other
organization, institution or person, that has records or knowledge of me/us or my/our insurability to give The Maritime Life Assurance Company or its reinsurers any such information. A
photographic copy of the signed authorization to obtain this information will be as legally valid as the original.
(please print)
Life Insured’s Name __________________________________________________________________ Payor’s Name ____________________________________________________________________
Life Insured’s/Guardian’s Signature _____________________________________________________ Payor’s Signature _________________________________________________________________
Date _______________________________________________________________________________

F15 Application for Insurance (Cont’d)
5. Personal Information
(Please circle) Life Insured Payor Please provide full details to any “Yes” responses
Height/Weight ______/______ ______/______
Gained or lost more than 10 lbs during the past year? Yes No Yes No
6. Have you in the past 5 years
• engaged in hazardous sports or activities or intend to do so? Yes No Yes No
• flown other than on a regularly scheduled flight? Yes No Yes No
Have you been convicted or charged with any moving violation
with respect to motor vehicle operation within the past 2 years? Yes No Yes No
If Yes, driver’s license number: ___________ ___________
7. Have you:
• used tobacco products within the past 12 months? Yes No Yes No
Date of last use: ____________ ____________
Have you:
• used cannabis or other drugs other than as prescribed by a physician? Yes No Yes No
• been treated or counselled for alcohol or drug usage? Yes No Yes No
Indicate weekly consumption of alcohol and type: ____________ ____________
8. Have you ever applied for insurance which was declined,
postponed, or modified in any way? Yes No Yes No
9. Have you ever had or been advised you had a disease or disorder of:
a) cardiovascular, circulatory or respiratory systems? Yes No Yes No
b) diabetes, kidney, liver, intestine or stomach disorder? Yes No Yes No
c) nervous system including epilepsy or any other brain or spinal cord problem? Yes No Yes No
d) cancer, tumor or cysts? Yes No Yes No
e) immune system disorders, including but not limited to AIDS related problems? Yes No Yes No
f) mental problems, including anxiety, depression, etc. Yes No Yes No
g) any other disease or condition not included above? Yes No Yes No
10. Have you ever been advised to have testing or treatment related
to your health which was not done? Yes No Yes No
11. Name and Address of your personal physician
12. Date and reason last consulted
MEDICAL INFORMATION BUREAU
Pre-Notice to Applicants regarding the Medical Information Bureau. Information regarding your insurability will be treated as confidential. The Maritime Life Assurance Company or its reinsurers may,
however, make a brief report thereon to the Medical Information Bureau, a non-profit membership organization of life insurance companies, which operates an information exchange on behalf of its
members. If you apply to another Bureau member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, the Bureau, upon request, will supply such
company with the information in its file. Upon receipt of a request from you, the Bureau will arrange disclosure of any information it may have on your life. If you question the accuracy of information in
the Bureau’s file, you may contact the Bureau and seek a correction. The address of the Bureau’s information office is 330 University Avenue, Toronto, Ontario, M5G 1R7, telephone (416) 597-0590.
The Maritime Life Assurance Company or its reinsurers may also release information in its file to other life insurance companies to whom you may apply for life or health insurance, or to whom a claim for
benefits may be submitted.
DECLARATION AND AGREEMENT
The Applicant, Payor and Proposed Life Insured hereby declare and agree that:
1. All statements and answers in connection with this application are true and complete. Insurance is a contract based on trust. Failure to fully disclose facts material to this application could make your
contract void.
2. The application and declaration together with any other statements made to the Company in connection with this application shall form the basis of this contract.
3. This application provides no insurance coverage prior to final approval and issue of the policy, and payment of the full modal premium. The coverage will take effect when the policy is delivered and the
final premium is paid, provided the health of the Proposed Life Insured and Payor has not changed materially since the application date.
4. Acceptance of a policy issued on this application shall constitute ratification of the amendments made by the Company under “Amendments by the Company” attached to the policy.
5. We understand that the Independent Advisor is a representative of The Maritime Life Assurance Company. The Independent Advisor is compensated for the sale of this contract by the payment of a
commission by The Maritime Life Assurance Company.
6. We request this policy be issued in English. Nous demandons que notre police soit rédigée en anglais.
7. We have received the information stub describing the function of the Medical Information Bureau.
I authorize Maritime Life to collect, use, and disclose personal information concerning me and/or my dependant(s) (where applicable) for the purpose of determining eligibility for Maritime Life products
and services; underwriting and administration of coverage; the adjudication and payment of claims and other relevant purposes, all of which are described in more detail in Maritime Life's Privacy Policy
and Privacy Information Package, available at www.maritimelife.ca or by request.
! I agree to the gathering of information for future marketing purposes concerning other products and services.
SIGNATURES
Life Insured/Guardian _________________________________________________________________ Payor ___________________________________________________________________________
Owner _______________________________________________________________________________________________________________________________________________________________
Signed in the City of __________________________________________________________________ in the Province of ________________________________________________________________
Witness (Advisor) ____________________________________________________________________ Date ____________________________________________________________________________

The Maritime Life Assurance Company
Head Office
PO Box 1030
Halifax, Nova Scotia
B3J 2X5
Halifax
Montreal
Toronto
Kitchener
Calgary
Vancouver
Visit our website at www.maritimelife.ca
E1462 (01/2004)