Corporate/Non-Corporate Entity Ownership Form - Transamerica ...
Corporate/Non-Corporate Entity Ownership Form - Transamerica ...
Corporate/Non-Corporate Entity Ownership Form - Transamerica ...
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<strong>Corporate</strong>/<strong>Non</strong>-<strong>Corporate</strong><br />
<strong>Entity</strong>/Trust <strong>Ownership</strong> <strong>Form</strong><br />
IP-LP1166 7/14
CORPORATE/NON-CORPORATE<br />
ENTITY/TRUST OWNERSHIP FORM<br />
500–5000 Yonge Street<br />
Toronto, ON M2N 7J8<br />
Applicant Name_________________________________________________________________________ Policy No. (if available)___________________________________________________________________<br />
corporation/non-corporate ENTITY/TRUST IDENTIFICATION – This form along with the International Tax Classification for an <strong>Entity</strong> <strong>Form</strong> (IP-LP1601) must<br />
be completed if the Owner(s) is a Corporation, <strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong> or a Trust.<br />
1. Please provide the following information on the individual(s) submitting an application on behalf of a Corporation, <strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong> or Trust.<br />
Identification<br />
Identification<br />
Name of Individual Job Title Document* Document Number* Issuing Jurisdiction*<br />
_______________________________ ______________________ _____________________ ____________________ ______________________<br />
_______________________________ ______________________ _____________________ ____________________ ______________________<br />
_______________________________ ______________________ _____________________ ____________________ ______________________<br />
*Please refer to an original non-expired passport, birth certificate, driver’s license, Canadian Citizenship, Age of Majority or Canadian Armed Forces Identification (preferably photo ID).<br />
2. Corporation – Please provide <strong>Corporate</strong> information including corporate structure document. For more information on supporting documents required refer to the<br />
Summary Table.<br />
_______________________________________________________________________________________________________________________________<br />
Official <strong>Corporate</strong> Name<br />
_______________________________________________________________________________________________________________________________<br />
Address<br />
_______________________________________________________________________________________________________________________________<br />
Place of Federal or Provincial Incorporation<br />
Corporation Registration Number<br />
Names of all Directors of Corporation (If necessary, attach listing of all directors)<br />
Occupation<br />
______________________________________________________________________________________________________________ __________________________________________________________________<br />
______________________________________________________________________________________________________________ __________________________________________________________________<br />
______________________________________________________________________________________________________________ __________________________________________________________________<br />
______________________________________________________________________________________________________________ __________________________________________________________________<br />
______________________________________________________________________________________________________________ __________________________________________________________________<br />
Names of all individuals Occupation Address<br />
who directly or indirectly own or control 25%<br />
or more of the shares of the Corporation.<br />
______________________________________________________________________________<br />
______________________________________________________________________________<br />
______________________________________________________________________________<br />
______________________________________________________________________________<br />
Note: Please submit this form with your application.<br />
_____________________________ __________________________________________________________________<br />
_____________________________ __________________________________________________________________<br />
_____________________________ __________________________________________________________________<br />
_____________________________ __________________________________________________________________<br />
*FRM-IPLP1166*<br />
IP-LP1166 7/14
3. <strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong> – Please provide <strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong> Information. For more information on supporting documents required refer to the Summary Table.<br />
_______________________________________________________________________________________________________________________________<br />
Official Name of <strong>Entity</strong><br />
_______________________________________________________________________________________________________________________________<br />
Address<br />
_______________________________________________________________________________________________________________________________<br />
Place of Issue<br />
Registration Number<br />
_______________________________________________________________________________________________________________________________<br />
Type of <strong>Entity</strong>/Document<br />
Name of all individuals who directly or indirectly own or control 25% or Occupation Address<br />
more of the <strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong>.<br />
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________<br />
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________<br />
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________<br />
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________<br />
4. Trust – Please provide Trust Information. For more information on supporting documents required refer to the Summary Table.<br />
Name of person who created the Trust (Settlor)<br />
Address<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
Name of Trustee<br />
Address<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
Name of Beneficiary<br />
Address<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
________________________________________________________________________________________________________ _____________________________________________________________________________________________________<br />
Certification by Authorized Signing Officer/person with signing authority of <strong>Entity</strong><br />
I certify the above is a full, complete and accurate disclosure in respect of the <strong>Entity</strong>. I also have the authority to sign this <strong>Form</strong> on behalf of the <strong>Entity</strong>.<br />
Print Name & Title _________________________________________________________________<br />
Signature________________________________________________________________________ Date (DD/MM/YYYY) ______________________________<br />
Advisor’s Notes and Comments<br />
________________________________________________________________________________________________________________________________________________________________________________________________________________<br />
________________________________________________________________________________________________________________________________________________________________________________________________________________<br />
________________________________________________________________________________________________________________________________________________________________________________________________________________<br />
Advisor Verification/Information<br />
I have verified the identity of the individual who submitted the application by referring to the original documents referred to above and that the information recorded was<br />
correctly copied from such document.<br />
Name of Advisor<br />
Signature of Advisor<br />
Date (DD/MM/YYYY)<br />
Dealer/GA Code<br />
Rep/Advisor Code
Summary Table<br />
Type of account<br />
Corporation<br />
(Complete section 1, 2 and sign Certification section)<br />
<strong>Non</strong>-<strong>Corporate</strong> <strong>Entity</strong><br />
(Complete section 1, 3 and sign Certification section)<br />
Trust<br />
(Complete section 1, 4 and sign Certification section)<br />
What information must be submitted<br />
• Name and address of the corporation<br />
• Names of all directors of the corporation<br />
• Names and addresses of all individuals who directly or indirectly own or control 25% or more of the<br />
shares of the corporation.<br />
(If this information cannot be obtained, we must keep a record explaining why beneficial ownership could<br />
not be determined).<br />
• Certificate of Incumbency<br />
• International Tax Classification for an <strong>Entity</strong> <strong>Form</strong> (IP-LP1601)<br />
• Name and address of the entity<br />
• Name and address of all individuals who directly or indirectly own or control 25% or more of the entity.<br />
(If this information cannot be obtained, we need to keep a record explaining why beneficial ownership<br />
could not be determined).<br />
• Certificate of Incumbency<br />
• International Tax Classification for an <strong>Entity</strong> <strong>Form</strong> (IP-LP1601)<br />
And include one of the following:<br />
• Partnership Agreement<br />
• Articles of association<br />
• Other similar record that confirms the entity’s existence<br />
• Name and address of all trustees<br />
• Name and address of all known beneficiaries<br />
• Name and address of all known settlors of the trust<br />
• Certificate of Incumbency<br />
• International Tax Classification for an <strong>Entity</strong> <strong>Form</strong> (IP-LP1601)<br />
And include one of the following:<br />
• Trust Agreement<br />
• Trust Deed<br />
• Declaration of Trust<br />
• Other similar record that confirms the entity’s existence<br />
500–5000 Yonge Street<br />
Toronto, Ontario M2N 7J8<br />
www.transamerica.ca<br />
® Aegon and the Aegon logo are registered trademarks of Aegon N.V. Aegon Canada ULC and its affiliated companies are licensed to use such marks.<br />
® <strong>Transamerica</strong> and the pyramid design are registered trademarks of <strong>Transamerica</strong> Corporation. <strong>Transamerica</strong> Life Canada is licensed to use such marks.<br />
IP-LP1166 7/14