Process date:

Scan date: Client Information Change Form

(Please check areas that apply)

May 1, 2019

Account Information

Fund Company Fund Account # Account Type Plan ID

Client Name(s) S.I.N # (s)

Client Address

Address City Province Postal Code

Country Telephone E-Mail

Client Information Change-Please change the following information for this client on your system to:

Date of Birth S.I.N # Gender Other

Client Name

Previous Last Name First Name Previous Signature

New Last Name First Name New Signature

(NOTE: Client must sign both previous and new signature, and attach a legal document with client’s new name)

Successor Annuitant Successor Holder Beneficiary Designation (Applicable to registered accounts only) I hereby revoke any previous successor annuitant, successor holder designation or any previous beneficiary designation with respect to this account. (Not for

RESPs)

A. In the event of my death I designate my spouse as my beneficiary and the person entitled to receive my interest in this account.

Spouse name Spouse S.I.N #

B. In the event that I have not designated my spouse and my spouse is not entitled to the benefits under my Plan*, I hereby designate the following person(s) as my designated beneficiary and the person(s) entitled to receive my interest in this account if living at my death.

% % Name Relationship Name Relationship

C. If (a) the successor annuitant or holder named above, if any, predeceases me or is not my spouse at the time of my death; or (b) I have not elected any successor annuitant or holder under my account; then I hereby designate the following person(s) as my designated beneficiary entitled to receive my interest in this account if living at my death.

Name Relationship

Caution: Any designation made in this section is subject to the following: For the purpose of this designation, spouse refers to a person recognized as your spouse or common-law partner for the purpose of the Income Tax Act (Canada). The validity of a designation of a beneficiary or successor annuitant is subject to the applicable pension legislation and the laws of the jurisdiction where you

reside, if any, permitting designations to be made otherwise than by way of a will. Your designation above will not be revoked or changed automatically by any future marriage or divorce. Should you wish to change your designated beneficiary

or successor annuitant, you will have to do so by means of a new designation. Any designation made above shall apply to this Account only. If you have other accounts for which you wish to designate a beneficiary or successor annuitant you

must complete a separate designation for each of these accounts.*Your spouse may automatically be entitled to benefits under your LRSP, LIRA, RLSP, RLIF, PRIF. Or LRIF

D. Add or Change an RESP Beneficiary

% % Name Relationship Name Relationship

S.I.N # D.O.B S.I.N # D.O.B

Registration-Please change the registration from the account information listed above to:

Account Type Client Name(s) S.I.N # (s) D.O.B

For Joint Accounts: One to sign Both to sign Joint in Common Joint with Rights of Survivorship

Distribution

Cash Reinvested Change banking information for cash distribution

Deposit to clients bank account (void check attached) Into same fund (void check attached)

Mail to client Purchase fund

Additional Notes

Client Signature (NO LTA MAY BE USED) Date Representative Signature Date

Portfolio Strategies Corp Joint Client Signature (NO LTA MAY BE USED) Date Dealer Name Dealer/Rep