Term conversion application · or exercising a GIO or BVP . INSTRUCTIONS . Use this form if: •...

Deposit option, NN0713E if adding a deposit option to a Performax Gold conversion

Financial statements for the last three years for the business to which the coverage applies

All owners of any policy described in this form

For a term conversion, all irrevocable beneficiaries and collateral assignees/hypothecary creditors on the existing policy.

Term conversion application or exercising a GIO or BVP

INSTRUCTIONS

Use this form if: • you are requesting a term conversion or the exercise of a guaranteed insurability option

(GIO), business value protector (BVP) option, or child rider insurability benefit, and

• evidence of insurability is not required

If evidence of insurability is required, use the Application for change, NN7001E (or Manulife Quick Issue Term® Application for change, NN7011E) instead.

If this is a conversion from group insurance, use a group conversion application.

CHECKLIST

The following documents (completed and signed) may also be required with this form:

Product page

Identifying owners of Individual Insurance policies, NN1558E for any product other than a Family Term, Business Term, or Family Term with Vitality policy if no product page is submitted

Signed illustration for any product other than a Family Term, Business Term, or Family Term with Vitality policy

Increase lifetime deposit option limit, NN1678E if increasing lifetime deposit option limit to aManulife Par conversion

Smoking and nicotine questionnaire, NN0710E (if exercising a child rider insurability benefit and applying for non-smoker rates)

Politically exposed person disclosure, NN1560E if there is a deposit of more than $100,000with this conversion application

Tax status change acknowledgement, NN1660E if you are converting to an existing policy that was issued on or before December 31, 2016

Initial premium payment or void cheque if paying by pre-authorized debit (PAD)

If exercising a BVP option:

Documentation showing the current equity position of each insured person in this business

Signatures required on this form:

People insured on any policy described in this form

All irrevocable beneficiaries and collateral assignees/hypothecary creditors on the policy to which insurance is added

Corporate signing officer(s), as described on page 14

All holder(s) of the account from which payments are to be made if they are not the policy owner or the person to be insured

The Manufacturers Life Insurance Company of 13 NN0431E (02/2019)

Glossary of terms used in this application

Account holder – the person who holds the bank account from which payments for your policy are or will be made.

Base coverage – the basic insurance you purchased that provides coverage on one or more insured people. You may have additions to the policy, called riders, that provide additional coverage. You can have a base coverage with no rider, but any rider must be attached to a base coverage. See Rider.

Benefit – the payment Manulife makes when they approve an insurance claim. See Coverage for more details about coverages.

Business number (BN) – a business number is a number assigned to a business for tax purposes, such as filing an income tax return. The Income Tax Act (Canada) requires us to collect and record this number if a policy is owned by a corporation.

Conversion – you can ask us to exchange your eligible coverage to new or existing permanent insurance policy without having to give us information about your health. A conversion can be full or partial:

Full – A full conversion means we exchange all the insurance from one existing coverage on your policy to a new or existing permanent insurance policy.

Partial – unlike a full conversion, with a partial conversion we only exchange some of your coverage. You may choose what you wish to do with the remaining, unconverted coverage, as long as your choice is allowed under the terms of the original contract and our administrative rules.

Coverage – the protection that an insurance policy or rider provides. You may have different coverages on a policy that insure different people. Each coverage provides a benefit that is paid when an insurance claim is approved. See Benefit.

Existing policy – we refer to the existing policy as Policy 1 (see Policy 1).

Monthly processing date – the day that most policy changes take effect on your policy. The first monthly processing day is on the policy issue date and subsequent ones are on the same day of each month that follows.

Option date – the date a specific event occurred that allows you to exercise a GIO or BVP option. For example the date of an insured person’s marriage, or the date the insured person or spouse gives birth to a living child. Your policy lists the specific life events that apply.

Original owner – an original owner is a person who purchased and owns the insurance policy being converted.

Policy 1 – the original policy with the coverages you are converting.

Policy 2 – the policy to which the converted coverage is added. Policy 2 may be a new policy established for your converted insurance, or an existing policy that meets the terms of the original contract and our administrative rules.

Rider – an addition to the base coverage that provides additional coverage. A rider must be attached to a base coverage; it cannot stand alone. See Base coverage.

Witness – signatures must be witnessed by a third party, who is present at the time the form is signed and sees the person sign. The witness must be someone who is not named in this application.


Send this form to Manulife at:

All provinces except Quebec

Individual Insurance 500 King Street North PO BOX 1669 WATERLOO ON N2J 4Z6 Fax: 1-877-763-8834

In Quebec

Assurance individuelle 2000 rue Mansfield, bureau 1310 MONTREAL QC H3A 3A1 Fax: 1-877-271-5494

Term conversion application or exercising a GIO or BVP

• The original insurer refers to the company that issued the insurance policy identified in section 1.0.

• We, us and our refer to The Manufacturers Life Insurance Company. • You and your refer to the policy owner(s), unless otherwise specified.

If you want more information about the insurance product you are considering, visit our client website at: Before you buy www.manulife.ca/b4ubuy

Policy 1 means the original policy, as identified in section 1.0 of this application, and Policy 2 means the policy on which we issue the converted insurance or the new insurance requested under the Guaranteed Insurability Option (GIO) or Business Value Protector (BVP) rider. In some cases Policy 1 and Policy 2 may be the same policy.

Will the coverage be converted to a new policy (Policy 2)? No, if no go to section 3.0

Yes, if yes, complete section 2.0

What is your language preference for the new policy?

English. You request that the contract and all other documents and correspondence relating to your policy be in English. Vous demandez que le contrat et tous les documents et la correspondance y afférents soient en anglais.

Français. Vous demandez que le contrat et tous les documents et la correspondance y afférents soient en français.

Who will own Policy 2? If you are converting to a new policy and don’t complete the owner information below, the owner of Policy 2 will be the same as the current owner of Policy 1.

1.0 Policy information

2.0 Policy ownership

2.1 Mailing address

If you are converting to new coverage on an existing policy, you cannot use this form to change ownership of that policy (use Transfer of ownership, NN0687E).

For Quebec policies only: If ownership changes, any person insured by the original policy must sign in section 9.1 to confirm their consent to the ownership change.

Original policy number (Policy 1 elsewhere in this document)

Owner #1 of Policy 2 Owner #2 of Policy 2

If this is a Commercial Union policy provide the Coverage ID number

Name of owner #1 of Policy 2 (first, middle initial, last), or full legal name of entity #1

Name of owner #2 of Policy 2 (first, middle initial, last), or full legal name of entity #2

SIN or Federal business number (BN from Canada Revenue Agency) SIN or Federal business number (BN from Canada Revenue Agency)

Relationship to Insured person

Address (street and number)

City or town

Province Postal code

Email (optional)

Address (street and number)

City or town

Province Postal code

Email (optional)

Relationship to Insured person


www.manulife.ca/b4ubuy

Multiple owners in all provinces except Quebec: If more than one owner is being named, we will set up the ownership as joint ownership with right of survivorship. This means policy ownership is shared between the joint policy owners and, if the policy is still in effect after the death of one of the joint owners, the deceased owner’s share automatically passes to the surviving joint owner or owners. If you want ownership of your policy to be set as a tenants in common instead of joint ownership with right of survivorship, check the box below:

Tenants in common (If you select this option, complete Establishing Tenants in Common Ownership for a Policy, NN0967E.)

Multiple owners in Quebec: If this policy is to be owned by more than one person, and if the policy is still in effect after the death of one of the owners, that owner’s interest will pass to their estate unless a subrogated policy owner has been named for that person’s interest in the policy in section 2.3 Naming a successor or subrogated owner.

Complete this section if you hold this policy as tenants in common, and you want to name another person to receive the owner’s interest in this policy after his or her death. You may also choose to complete this section if there is only one owner and the policy may continue after that owner’s death. Identifying another person to take over ownership results in a faster and easier transfer.

For policies signed and issued in all provinces except Quebec: We recommend you do this if there is only one owner and the policy may continue after that owner’s death.

For policies signed and issued in Quebec: For a policy governed by Quebec legislation, we recommend that you do this if the policy may continue after a policy owner’s death.

If there is a disability waiver rider on Policy 1, are any people insured by that rider currently totally

disabled and unable to perform the duties of their regular occupation? No Yes

Only if you are applying to convert to a Family Term with Vitality policy:

2.2 Multiple owners

2.3 Naming a successor or subrogated owner

Relationship is required to help us determine the tax consequences of the transfer.

Owner #1 of Policy 2 Owner #2 of Policy 2

Name of owner #1 Name of owner #2

Name of successor or subrogated owner #1 (first, middle initial, last)

Relationship to owner of Policy 2

Name of successor or subrogated owner #2 (first, middle initial, last)

Relationship to owner of Policy 2

Insured person “A” Insured person “B”

Insured person “A” Insured person “B”

Insured person (first, middle initial, last)

Date of birth (dd/mmm/yyyy) Sex

Female Male

Email address of insured person “A”

3.0 Information about person(s) to be insured

3.1 If there is a disability waiver

Insured person (first, middle initial, last)

Date of birth (dd/mmm/yyyy) Sex

Female Male

We use this email address to communicate with you about registering and participating in the Manulife Vitality program. You must tell us if your email address changes.

What coverage # are you converting?

How much of that term coverage:

How much term coverage is on the existing policy?

• do you want to convert to permanent insurance

• is carried in a term insurance rider

• do you want to keep on the existing policy

• is left over (this remaining balance will be deleted)

issue the coverage as a new policy OR add the coverage to this existing policy _______________________________

Submit a signed and completed product page for the new coverage with this application.

$

$

$

$

$

$A

$B

$C

$D

$E (B+C+D+E must equal A)

We will convert your coverage, subject to our administrative rules, as shown on your Insurance coverage or Coverage details section of your signed product page.

There may be a taxable gain if the term policy you are converting has cash value at the time of conversion.

4.0 Tell us about the term coverage you are converting


4.1 Child rider with a critical illness insurability benefit

Complete this section to purchase insurance through:

• a Children’s Lifecheque Rider with a coverage date on or after April 4, 2016, or

• another child rider insurability benefit or a critical illness insurability benefit with a coverage dateon or after June 21, 2008.

Are you applying to convert a child rider (e.g. Child protection rider, Children's insurance rider) or to purchase

insurance through a critical illness insurability rider? No Yes, if yes, complete section 4.1

If you are applying to convert a child rider with a critical illness insurability benefit, or purchase insurance through a critical illness insurability benefit, the insured person must answer the following questions:

1. Do you have or have you applied for critical illness insurance that provides a total coverage shown below, with The Manufacturers Life Insurance Company and other insurance companies?

If the child rider is on a Lifecheque® policy $1,800,000 or more If the child rider is on a policy other than Lifecheque $1,900,000 or more

No Yes

2. Have you ever been diagnosed with cancer of any kind, heart attack, coronary artery disease requiring surgery or any condition requiring coronary angioplasty, stroke, multiple sclerosis, aplastic anemia, bacterial meningitis, blindness, deafness, loss of speech, kidney failure, paralysis, loss of limbs, coma, dementia including Alzheimer’s disease, motor neuron disease, HIV, Parkinson’s disease and specified atypical parkinsonian disorders, severe burns, benign brain tumour or have you been placed on the waiting list for or undergone a major organ transplantation, or undergone aortic surgery or heart valve replacement, or do you require assistance to perform any of the routine activities of daily living, including bathing, dressing, eating, toileting, transferring and maintaining continence?

No Yes

If you answered yes to question 1 or 2, we regret that we cannot offer you critical illness insurance without additional evidence of your insurability. If you want to apply for critical illness insurance by providing evidence of insurability, complete and submit the Application for life, disability, and critical illness insurance, NN7000E.

3. If you answered no to questions 1 and 2, tell us the amount of insurance you want to purchase:

a. For Lifecheque only: You may buy critical illness insurance as long as the amount of insurance is at least the minimum we describe in our administrative rules and no more than two times the children’s Lifecheque rider coverage amount, up to a maximum of $200,000.

Insurability benefit option: age 21 of insured child

age 65 of insured parent (coverage expiry)

life event

Current coverage amount

$

Life event (e.g. birth of child)

New amount of critical illness insurance

$

What proof of the life event is being submitted? (e.g. birth certificate)

b. Children's rider for critical illness insurability under a policy other than Lifecheque: You may buy a combination of life insurance and critical illness insurance as long as the total amount of insurance is not more than $250,000 and the critical illness portion of the total insurance is not more than $100,000.

Amount of life insurance

$

Amount of critical illness insurance

$

4.2 GIO or BVP option information

Are you applying to exercise a Guaranteed Insurability Option (GIO) or Business Value Protector (BVP)

No Yes, if yes, complete section 4.2

BVP

or

GIO: age policy anniversary alternative

Option date (dd/mmm/yyyy) Life event establishing alternative option (e.g. birth of child)

What proof of the life event is being submitted? (e.g. birth certificate)

4.3 Remaining riders or benefits

Where your existing policy permits, we will transfer the term coverages, riders and benefits to the new policy as you indicated on your signed product page.

A rider coverage must be attached to a base coverage. Before we complete the conversion, we will delete any rider that remains without an attached base coverage.


5.0 Beneficiary designations About beneficiary designations:

• The beneficiary designations made here apply to the new insurance only. If you do not designate beneficiaries for the new insurance, any benefit payable under the new insurance will be payable to the owner of the new insurance or his/her estate.

• Minor children cannot give written consent to policy changes.

• If you name an irrevocable beneficiary, you cannot make changes to the policy, assign its benefits or cash value, withdraw funds from it, or transfer its ownership without the beneficiary’s written approval. Parents or guardians of irrevocable beneficiaries who are children cannot give approval on their behalf. Approval must come directly from the beneficiary, and a minor cannot give this approval.

• If you believe your circumstances warrant designating your beneficiaries as irrevocable, we strongly recommend you first discuss this with your advisor.

If you name more than one beneficiary, tell us the percentage of the benefit that each primary beneficiary is to receive. Otherwise, we will divide the benefit evenly among the surviving primary beneficiaries. If a person is disqualified, for any reason, from receiving a benefit payable, the benefit will be paid as if the disqualified person had died before it became payable.

A copy, fax, scan, or image of this beneficiary designation is as valid as the original.

5.1 Beneficiary information for life insurance

Beneficiaries (other than a spouse under a Quebec policy) are revocable unless you write the word “irrevocable” after that beneficiary’s name.

For the new policy, if you do not complete this section, any benefits payable under the new policy will be payable to the owner of the new policy or their estate.

Secondary beneficiary information

A secondary beneficiary (also know as a contingent beneficiary or subrogated, in Quebec) receives a death benefit only if no primary beneficiaries are alive when the insured person dies or if all primary beneficiaries are disqualified.

Primary beneficiaries designated for insured person “A”

Primary beneficiaries designated for insured person “B”

For policies issued in Quebec only: If you named your married or civil union spouse as a beneficiary, the designation is irrevocable unless you select revocable.

Revocable Revocable

* In Quebec, tell us the beneficiary’s relationship to the owner. In all provinces except Quebec, tell us the beneficiary’s relationship to the insured person.

Beneficiary name (first, middle initial, last) Beneficiary name (first, middle initial, last)

Relationship* % share Relationship* % share





Shares must total 100% Shares must total 100%

Secondary beneficiaries designated for insured person “A”

Secondary beneficiaries designated for insured person “B”

Secondary beneficiary (subrogated in Quebec) name (first, middle initial, last)









Shares must total 100% Shares must total 100%


The illustration shows the MICR encoding used on standard cheques. The labels help you identify the

500 KING ST. NORTH codes to enter in the following table. WATERLOO, ONTARIO N2J 4C6

MEMO

"108 01122540 00011001111"

Transit number Institution number Account number

Complete this section if a beneficiary named above is a minor. Your signature in section 9.2 confirms thatyou agree that any benefit that becomes payable to a minor child will be paid to the trustee to hold in trust for the child until the child reaches legal age.

5.2 Trustee for minor beneficiaries (not applicable in Quebec)

Trustee for minor beneficiaries designated Trustee for minor beneficiaries designated for insured person “A” for insured person “B”

Trustee name(s) (first, middle initial, last) Trustee name(s) (first, middle initial, last)

Relationship of trustee to beneficiary Relationship of trustee to beneficiary

6.0 Special instructions

$

Name of Canadian bank or financial institution Transit number Institution number Account number

7.0 Billing information

If an account holder is not the policy owner or one of the people to be insured under the policy, they must sign in section 10.0 to authorize the withdrawals.

* Pre-authorized debit must bein Canadian funds drawn on aCanadian bank or financialinstitution.

7.1 Unused premiums from the old policy

In this section you and your refer to the policy owner

a. Who will be paying your premiums?

Owner #1 Person A to be insured Owner #2 Person B to be insured

Complete the following account holder information if any payor or joint bank account holder is not one of the above:

Account holder #1

Name (first, middle initial, last) or full legal name of corporation, including Company, Limited, Inc., etc.

Account holder #2

Name (first, middle initial, last) or full legal name of corporation, including Company, Limited, Inc., etc.

b. What is the amount of your first payment?$

c. How will the payments be made?

by pre-authorized debit* complete section 7.2 Pre-authorized debit plan

monthly annually (first payment only)

annually, by cheque payable to Manulife

d. For universal life or whole life policies only

calculate the minimum payment OR the total planned deposit is

Original owner(s): Initial here to authorize us to move the unused premiums to pay premiums on the converted policy.

If this box is not initialed, we will refund the unused premiums to the original owner(s).

7.2 Pre-authorized debit plan

* The withdrawal date must be atleast 4 days prior to the monthlyprocessing date.

Request for pre-authorized debit plan Policy number on which the current pre-authorized debit plan is set up

add this pre-authorized debit to an existing pre-authorized debit plan with us

OR

set up a new pre-authorized debit plan using the banking information below. (1st through 28th)*

If this is a regular monthly payment, tell us the withdrawal date for monthly pre-authorized debit

What banking information should we use?

from the attached void cheque (attach the cheque to this page.)

as follows: (Only complete the table below if you do not have a void cheque.)


7.3 Billing information and certification

Pre-authorized debits

Variable amount monthly pre-authorized debits for subsequent payments

Monthly pre-authorized debit plan

Your personal information

Authorizations include authorization and certification for billing information, and authorizations and consent required by the new owner

In this section you and your refer to the owner(s) of the bank account from which withdrawals will be made.

Authorizing pre-authorized debits from your bank account If the owner or the insured person is paying the premiums, their signature in section 9.1 or 9.2 means that they have read and agree to the authorizations in this section. They do not have to sign in this section.

By asking us to take payments from your bank account, you agree that you have read and agree to the following information.

Authorizing variable amount monthly pre-authorized debits to make your subsequent payments If you have asked us to establish a monthly pre-authorized debit plan to pay your regular premiums, you agree to the following:

• you authorize us to make monthly withdrawals from your bank account to pay for the policy

• except as otherwise stated in this agreement, the withdrawals will occur on the date that you specified above

• the withdrawals from your bank account are in variable amounts. This means they may increase as required to administer the policy (example: if the premiums for the policy are scheduled to change)

• if you have a policy with insufficient account value to cover the monthly deduction, we will not increase the payments withdrawn from your bank account to prevent your policy from terminating, and

• you waive the right to receive 10 days’ notice of the amount and date of each monthly pre-authorized debit to be made from your account.

The pre-authorized debit for your monthly payments will be treated as a personal pre-authorized debit (PAD) as defined by Payments Canada in Rule H1 at www.payments.ca.

What we will do if your bank or financial institution does not honour a monthly pre-authorized debit If your bank or financial institution does not honour a monthly pre-authorized debit the first time we present it for payment, we may attempt to withdraw that payment again within 30 days.

If that withdrawal is not honoured, we may attempt to withdraw that amount again together with your next month’s monthly pre-authorized debit.

We reserve the right to end the monthly pre-authorized debit plan immediately if a withdrawal is not honoured.

Making changes to your monthly pre-authorized debit plan You can request changes to the amount of the monthly pre-authorized debit or the account from which the monthly pre-authorized debit is being taken by telephone or in writing. We must receive the request at least three days before the monthly pre-authorized debit date. The advisor for this policy can also make these changes on your behalf.

Universal life or whole life policies For universal life or whole life policies, we have the right to change your monthly pre-authorized debit date to be at least four days before your monthly processing day.

Personal withdrawals All monthly pre-authorized debits from your bank account will be treated as personal withdrawals as defined by Payments Canada in Rule H1 at www.payments.ca.

Cancelling this agreement You or we can end this agreement at any time by giving 10 days’ written notice, counted from the date the notice is mailed. For a sample cancellation form or more information about cancelling a monthly pre-authorized debit plan, contact your bank or financial institution or visit www.payments.ca.

Unauthorized withdrawals You have certain recourse rights if any withdrawal does not comply with this agreement. For example, you have the right to receive reimbursement for any withdrawal that is not authorized or is not consistent with this agreement. To obtain more information on your recourse rights, contact your bank or financial institution or visit www.payments.ca.

Your personal information You authorize us to collect, use, release and exchange any personal information necessary to fulfill any obligations relating to withdrawals made from your bank account.

For more information about withdrawals from your bank account If you have any questions or concerns about withdrawals from your bank account, contact us at 1-888-626-8543 in all provinces except Quebec and at 1-888-626-8843 in Quebec. For more information about your rights, contact your bank or financial institution or Payments Canada at www.payments.ca.


www.payments.ca

www.payments.ca

www.payments.ca

www.payments.ca

www.payments.ca

7.3 Billing information and certification (continued)

8.0 Authorization and consent

Certification You certify that all people whose signatures are required on this account have signed in sections 9 and 10, including any required joint account holders or corporate signing officers.

• If an account holder is the policy owner or one of the people to be insured under the policy, their signature in section 9.1 or 9.2 is authorization for monthly pre-authorized debits.

• If an account holder is not the policy owner or one of the people to be insured under the policy, they must sign below to authorize the withdrawals in section 10.0.

• If withdrawals are to be made from a joint account, both account holders must sign if your bank or financial institution requires both signatures.

• If withdrawals are to be made from a corporate account, identify the corporate account and provide the signatures and titles of two corporate signing officers or the signature and title of one signing officer and the corporate seal. If the corporation does not have a corporate seal and you are the only person authorized to sign on behalf of the corporation, sign in the box for account holder #1 and write your initials in the box provided.

Please read this entire section carefully. It explains how your personal information is used to issue and administer the policy or policies. In section 9.1 and 9.2 we ask you to sign. Your signature means that you authorize and agree to the ways we collect, use, share and retain your personal information and that you agree to the terms described in this application. You may not alter any of the wording in section 8.0. Any attempt to do so will be of no effect. If you wish to withdraw your consent or opt out of direct marketing, please see the relevant section below.

In this statement, you and your refer to the policy owner or holder of rights under the policy, the life insured, and the parent or guardian (tutor, in Quebec) of any child named as life insured who is under the age of 16 (or under 18 in Quebec). We, us, our, and the Company refer to The Manufacturers Life Insurance Company, and our affiliated companies and subsidiaries.

Updates to this statement and further information about our privacy practices are posted to www.manulife.ca.

We collect, use, verify, and disclose your personal information for identified purposes, and only with your consent, or as permitted or required by law. By signing the application, you give your consent for us to collect, use, and disclose your personal information, as set out in this statement. Any alterations to the consent must be agreed to in writing by the Company.

What personal information do we collect? Depending on the product you have applied for, we collect specific personal information about you, such as:

• identifying information, such as your name, address, telephone number(s), email address, your date of birth, driver’s license, passport number, or Social Insurance Number (SIN)

• information about how you use our products and services, and information about your preferences, demographics, and interests

• other personal information we may require to administer our business relationship with you.

We use fair and lawful means to collect your personal information.

Where do we collect your personal information from? We collect your personal information from:

• your completed applications and forms

• other interactions between you and the Company

• other sources, such as:

• your advisor or authorized representative(s)

• third parties with whom we deal in issuing and administering your policy now and in the future

• public sources, such as government agencies or internet sites.

What do we use your personal information for? We will use your personal information to:

• help us properly administer the products and services that we provide, and to manage our relationship with you

• confirm your identity and the accuracy of the information you provide

• evaluate your application and issue and administer the rights under the policy

• comply with legal and regulatory requirements

• understand more about you and how you like to do business with us

• analyze data to help us understand our customers better, so we can improve the products and services we provide

• determine your eligibility for, and provide you with details of, other products or services that may be of interest to you.


www.manulife.ca

8.0 Authorization and consent (continued)

Who do we disclose your information to? We disclose your information to:

• persons, financial institutions, and other parties with whom we deal in issuing and administering your policy now and in the future

• authorized employees, agents, and representatives

• your advisor and any agency that has entered into an agreement with us and has supervisory authority, directly or indirectly over your advisor, and their employees

• any person or organization to whom you gave consent

• people who are legally authorized to view your personal information

• service providers who require this information to perform their services for us (for example data processing, programming, data storage, market research, printing and distribution services, paramedical, and investigative agencies).

The abovementioned people, organizations, and service providers are both within Canada and jurisdictions outside Canada, and would therefore be subject to the laws of those jurisdictions.

Where personal information is provided to our service providers, we require them to protect the information in a manner that is consistent with our privacy policies and practices.

How long do we keep your information? We keep your information the longer of:

• the time period required by law and by guidelines set for the financial services industry, or

• the time period required to administer the products and services we provide.

Withdrawing your consent You may withdraw your consent for us to use your SIN or Business Number, if applicable, for non-tax administration purposes. You may also withdraw your consent for us to use your personal information to provide you with other service or product offerings, excluding those mailed with your statements.

You may not withdraw your consent for us to collect, use, retain, or disclose personal information we need to issue or administer the policy unless federal or provincial laws give you this right. If you do so, a policy may not be issued and benefits will not be payable under the policy, or we may treat your withdrawal of consent as a request to terminate the policy.

If you wish to withdraw your consent, phone our customer care centre at 1-888-MANULIFE (626-8543), or 1-888-MANUVIE (626-8843) in Quebec, or write to the Privacy Officer at the address below.

Accuracy and Access You will notify us of any change to your contact information. You have the right to access and verify your personal information maintained in our files, and to request any factually inaccurate personal information be corrected, if appropriate. If you have a question, a concern, or wish to receive more information about parties who have access to your information or about our privacy policies and procedures, and/or wish to review your personal information in our files or correct any inaccuracies, you may send a written request to:

Privacy Officer Manulife 500 King Street N. Waterloo, ON N2J 4C6 [email protected]

Please note the security of email communication cannot be guaranteed. Do not send us information of a private or confidential nature by email. By contacting us via email you are authorizing us to communicate with you by email.

Opting out of direct marketing You have the right to opt out of additional product offerings. By withdrawing your consent for us to use your personal information for the purpose of marketing, you understand it will not affect our ability to continue to provide you with the products and services you have requested, but it will exclude you from receiving direct personalized marketing or special offers on other products and services.

How we resolve complaints To discuss any questions or concerns you may have, please contact your advisor or our head office at:

1-888-626-8543 in all provinces except Quebec or 1-888-626-8843 in Quebec

More information about our complaint resolution process is available on the Internet at www.manulife.ca under Contact Us > Complaint resolution.


www.manulife.ca

mailto:[email protected]

8.1 Consent to convert or to exercise the GIO, BVP or CPR

In this section, you and your mean the insured person(s), the owner(s) of Policy 1 and Policy 2, the parent or guardian (tutor, in Quebec) of any insured children under age 16 (under age 18 in Quebec) and any collateral assignee, hypothecary creditor or irrevocable beneficiary.

The Income Tax Act (Canada) introduced new tax rules for life insurance policies that are effective January 1, 2017. If your original policy was issued before that date, it may be subject to the new tax rules if you make a change that takes effect on or after January 1, 2017 and if that change either requires medical underwriting, or results in a new policy or coverage being issued after 2016. An existing policy that becomes subject to the new rules may require a withdrawal to keep its exempt status and the withdrawal could increase your taxable income. If we cannot adjust your policy to maintain its exempt status, it may become non-exempt. A new policy issued on or after January 1, 2017 may not allow you to make the same level of additional payments or deposits as your original policy. When the original policy ends, there may be tax consequences, which may include increasing your taxable income. Talk to your advisor and be sure you understand the tax consequences of any change to your policy.

By signing in section 9.1 or 9.2, you consent to the conversion of insurance or the exercise of the option or rider, as described in this application, and

• you make all declarations, acknowledgments and authorizations and give all consents as described in this application.

• you authorize the original insurer to release all information connected with Policy 1 to us and applicable reinsurers and authorize us to use it, as described in section 8.0.

• you agree that we have the right to contest the new insurance based on the evidence of insurability submitted when the original insurer issued or last reinstated Policy 1. This means that we may be entitled to void the new insurance if a material misrepresentation was made in connection with Policy 1.

• you agree that if we issue a policy under the terms of this application, the effective date of the new coverage will be shown on the contractual document that we send describing the new insurance.

• you acknowledge that on the effective date of the new insurance, the coverage you are converting and any coverage you ask us to cancel will be cancelled. Depending on the amount of insurance you are converting and cancelling, this may mean that Policy 1 will terminate.

• you agree that the new insurance that comes into effect as a result of this application satisfies the original insurer's obligation to provide additional insurance under the original policy. The original insurer is released from this obligation to the same extent that the original insurer would have been released if they had provided the new insurance.

• if you are converting insurance, you acknowledge that time limits for contestability and suicide run from the later of the date the insurance you converted was issued or last reinstated.

• if you are exercising a GIO or BVP option or purchasing insurance under a child rider, you acknowledge that the time limits for contestability and suicide run from the later of the date the new insurance was issued or last reinstated.

• if you are a collateral assignee (hypothecary creditor in Quebec), you acknowledge that we will not be bound with respect to the new insurance until we receive a copy of the new assignment or hypothec of that new insurance at our head office.

• if you are an irrevocable beneficiary, you acknowledge that your rights under Policy 1 will only be carried forward to Policy 2 if you are designated as an irrevocable beneficiary in Policy 2.

• if you own Policy 1 but will not own Policy 2, you acknowledge that you do not gain any ownership rights in Policy 2 as a result of this conversion or exercise of GIO or BVP rider.

• if the owner of Policy 2 is different than the owner of Policy 1, and Policy 2 is a Performax Gold or universal life policy, you acknowledge that any accumulated additional payment or deposit room in Policy 1 does not carry forward to Policy 2.


8.1 Consent to convert or to exercise the GIO, BVP or CPR (continued)

Signatures

Sign below to confirm that you agree to the terms of this application that apply to you:

• you acknowledge that approval of your application is subject to contract provisions and our current administrative rules

• you have read this application and confirm that the statements in it are correct and complete; if you have not read the application, you confirm that you will read it when the policy is delivered; you will immediately notify us of any errors or omissions

• you have read and understood the final version of the policy illustration (if one is required), including the fact that some values in the policy may not be guaranteed; you will contact us immediately if you have any concerns regarding your illustration

• you agree to the terms described in the application

• a copy, fax, scan or image of the beneficiary designation in this application is as valid as the original.

Signed at (city or town, province)9.0 Signatures

9.1 Signatures of insured persons

Policy 1

Signature of insured person “A”

✘Title

Signature of witness

✘

Date (dd/mmm/yyyy)

Signature of insured person “B”

✘ Title


✘ Date (dd/mmm/yyyy)

9.2 Signatures of owners Policy 1 Policy 2

Signature of owner #1 of Policy 1 (if not one of the insured)

✘ Title


✘ Title

Signatures for Policy 2 are only needed if different from Policy 1


✘ Signature of witness

✘ Date (dd/mmm/yyyy) Date (dd/mmm/yyyy)

If the policy owner is a corporation, we also require:

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.

Initial here• the signatures and titles of two signing officers

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. or

• the signature and title of one signing officer and the corporate seal.


✘ Title


✘ Title


✘ Signature of witness

✘ Date (dd/mmm/yyyy) Date (dd/mmm/yyyy)

9.3 Other signatures required

Policy 1

If a beneficiary is an irrevocable or preferred beneficiary they must sign to agree to the transfer of ownership and/or the beneficiary change and to release his or her interest as a beneficiary.

If Policy 1 is collaterally assigned or in Quebec, hypothecated, the assignee must sign to agree or obtain a Release of Assignment or Release of Hypothecation. For financial institution assignees, we require 2 authorized signatures.

(for Policy 1 only)

If Policy 2 is a new policy and your intention is to assign it, you must complete Collateral assignment, NN0504E or, for policies governed by Quebec law, Hypothecation of rights under an insurance contract, NN1542E.

Signature of irrevocable or preferred beneficiary for Policy 1

✘ Title



Collateral assignee/hypothecary creditor for Policy 1

✘ Title




Collateral assignee/hypothecary creditor for Policy 1

✘ Title




10.0 Additional signatures for banking information • a corporate signing officer, or

If you have changed your banking information, sign here only if you are:

• not a policy owner or person insured under this policy

Policy 2, Account holder # 1 Policy 2, Account holder # 2

Additional signatures may be required if you have changed your banking information.

Name of account holder #1 or corporate signing officer #1 (first, middle initial, last)

Name of account holder #2 or corporate signing officer #2 (first, middle initial, last)

Signature of account holder #1 or corporate signing officer #1

✘ Signature of account holder #2 or corporate signing officer #2

✘ Title (if applicable) Date (dd/mmm/yyyy) Title (if applicable) Date (dd/mmm/yyyy)


11.0 Advisor’s statement In this section, you and your refer to the advisor. List the advisors involved in this application for change. If the servicing advisor shown is not the original servicing advisor, we will update our records to use the servicing advisor shown below.

Name of servicing advisor (first, middle initial, last) Name of advisor (first, middle initial, last)

Advisor code Branch code Commission share Advisor code Branch code Commission share

% %

By signing below, you confirm: • you hold all necessary licenses and certificates to write this application for change in your jurisdiction

and the jurisdiction where the policy owner resides, • if this change involves replacing another policy, you have made all proper disclosures to your client

and completed the appropriate replacement documents, and provided these documents to us, if necessary,

• you have disclosed the following information to the owner of this policy: • the name of the company or companies you represent, • you receive commissions for the sale of life and living benefits insurance products and may receive

bonuses, invitations to conferences or other incentives, and • any conflicts of interest you may have with respect to this transaction.

Signature of servicing advisor

✘ Email address or telephone number for advisor

12.0 Contact information (for head office use only)

For advisors who are not contracted through a Managing General Agency (MGA) or National Account (NA),if we have questions about this application, who should we contact?

The advisor listed above an assistant or other contact listed below

Name of advisor assistant or other contact

Email address Telephone number


Term conversion application · or exercising a GIO or BVP . INSTRUCTIONS . Use this form if: •...

Documents

Transcript of Term conversion application · or exercising a GIO or BVP . INSTRUCTIONS . Use this form if: •...