imaxxGIF Application - Transamerica Life Canada

imaxxGIF Application Effective: January 2014Please print firmly. Any changes must be initialled by the Owner.Policy No. _______________________In this application, “you” and “your” mean the person who is theowner or holder of rights under the Contract. “We,” “our,” “us,”and “Transamerica” mean Transamerica Life Canada.1. plan typEPlease select one.†Available for Federal Plans only.m Retirement Income Fund (RIF)m Spousal RIFm Life Income Fund (LIF)m Prescribed Retirement Income Fund (PRIF)m Restricted Life Income Fund (RLIF) †For a LIF, PRIF or RLIF, the Contract is to be governed by the laws of: insert name of province ____________ or if Federal Plan“Canada,” as applicable.RRIF minimum calculation:m Qualifying (RRIFs opened prior to January 1, 1993)m Non-qualifying (RRIFs opened after December 31, 1992)2. NOMINEE INFORMATIONIf this policy is classified as a nomineeplan, the policy will be non-registeredat Transamerica.Is this a nominee plan?m Nom YesCross Reference #__________________________________ Type of registration with nominee ________________________________3. OWNER/annuitant INFORMATIONThe Owner must be a Canadian resident atthe time the application is completed.The Owner must also be the annuitant.ONLY ONE PERSON CAN BE THE ANNUITANTm Mr.m Mrs.m Ms.m Missm OtherLast Name First Name Initial(s)Street Address Apt Language Preferencem English m FrenchCity Province Postal Codem Malem FemaleSocial Insurance NumberOptional: Phone Number:Principal Business or Occupation:Date of BirthDD/MM/YYYYE-mail address:4. Spousal informationComplete if:• When legislation permits, the annualminimum payment is to be determinedbased on your spouse’s age in a RIF/LIF/LRIF/PRIF/RLIF contract. This electioncannot be changed, even on marriagebreakdown (e.g., separation, divorce)or the death of your spouse.m Mr.m Mrs.m Ms.m Missm Otherm Malem FemaleLast Name First Name Initial(s)Street AddressCity Province Postal CodeSocial Insurance NumberPrincipal Business or Occupation:Date of BirthDD/MM/YYYYApt5. SUCCESSOR ANNUItantINFORMatION (OPTIONAL)Only the spouse can be designated assuccessor annuitant.The successor annuitant takes theannuitant’s place upon the death of theannuitant named in Section 3. As a result,the policy continues. The death benefitis payable on the death of the annuitantor successor annuitant, whicheverhappens later.The successor acquires all the holder'srights upon the holder's death including theunconditional right to revoke any beneficiarydesignation made by the holder.m Mr.m Mrs.m Ms.m Missm Otherm Malem FemaleLast Name First Name Initial(s)Street AddressCity Province Postal CodeSocial Insurance NumberTransamerica Life Canada • Copy 1: Head Office Copy 2: Advisor Copy 3: Dealer/G.A. Copy 4: ClientDate of BirthDD/MM/YYYYApt*FRM-IP881*IP881 1/14