Wire Payments 'Fixed Templates' Request FormVersion 6

Enter Type of Request:

Refer to page 3 for instructions and definitions necessary for completion of this request. Please complete all mandatory fields to avoid processing delays.Mandatory fields are denoted with an asterisk "*" when a Request Type is chosen on the form.PLEASE BE AWARE THAT PROCESSING TIME IS 5 BUSINESS DAYS.

BENEFICIARY BANK DETAILS

Street Address:

Bank Name:

Payment Currency:

City:

Country:

Beneficiary Account No:

Bank ID:

Date:

Payment Destination:

CUSTOMER INFORMATION

Customer Name:

Phone No:Completed By:

Company ID:

BENEFICIARY DETAILS

Street Address:

Beneficiary Name:

Country:

City:

MM/DD/YYYY

Payment Type:

14686 (0613)Page 1 of 6

ext:

Template ID:

ForeignProv/State:

Prov/State:

ForeignProv/State:

Prov/State:

Template ID:

CUSTOMER INFORMATION

Company ID:

Reason for Payment:

INTERMEDIARY BANK DETAILS (mandatory if you are using an intermediary bank)

Street Address:

Bank Name: City:

Country:

INSTRUCTIONS

Bank ID:

For Beneficiary:

Branch Signature Date (MM/DD/YYYY)

To be completed by Branch

Branch Phone NumberBranch Contact Name Transit Number

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For TD Bank:

ForeignProv/State:

Prov/State:

TD will reject any fixed template received if it does not contain all of the information required by TD. Notwithstanding the foregoing, if TD is able topopulate/correct the fixed template with sufficient information in order for it to be accepted, TD may, but is not obligated to do so. You authorize TD topopulate/correct the fields identified below without notice to you:

- The Payment Type field if it has been incorrectly populated and the Payment Type should be a Payment to Customer or a Payment to Bank- The Payment Destination field if Payment Destination should be to a Non TD account or another TD Account, determined based on the Beneficiary

Bank Details- The Bank ID field, if the Bank ID field is invalid or incomplete based on the Beneficiary Bank Details;- Deletion of the Intermediary Bank Fields if these details are not required.

Authorized Signing Authority(s) of Company

__________________________________________ ______________________________________________Signature of Signing Authority Signature of Signing Authority

__________________________________________ ______________________________________________Name Name

INSTRUCTIONS FOR COMPLETING THE WIRE PAYMENTS FIXED TEMPLATE REQUEST FORM:1. Before you submit this form you must already be established as a Fixed Template customer. For more information contact your Branch.2. Select from the following options from the dropdown box to enter the type of request for the Fixed Template:

'Add' if a new template needs to be added,'Change' if changes are required for an existing template,'Delete' if an existing template needs to be deleted.

3. Print and sign the completed Fixed Template Form and fax pages 1 and 2 to your TD branch contact. Requests cannot be processedwithout both pages.

4. Please be aware that processing time is 5 business days. These instructions will be held at TD and only these templates will be acceptedfor Wire Payment Processing.

5. Please follow the guidelines in the table below to complete your request and complete all mandatory fields. If mandatory fields are notcompleted, the request will be returned for completion which will result in processing delays. Mandatory fields are listed in the tablebelow and are denoted by an asterisk "*" on pages 1 and 2 of the form when a request type is selected. Enter the wire paymentinstructions within the field character length available for each field. The character length provided is based on global industrystandards. Additional tips are available below and this form contains logic that will display error messages and/or reminders whencompleting the form. Be sure to use the CLEAR button found on the form to begin each new Fixed Template Request. Use the PRINTbutton found on the form to ensure all mandatory fields have been completed before printing.

NOTE: Utilizing the guidelines here will assist with processing of your request, but does not guarantee that it will not be returned forclarifications or corrections that will delay processing time.

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Field Name

Customer InformationCompany ID

Customer NameCompleted ByDatePhone Number/Ext.Authorized Signing Authority (s)of the CompanyTemplate ID

Payment Type

Payment Destination

Beneficiary DetailsBeneficiary Name

Street AddressCountryCityProv./StateForeign Prov./State

Mandatory/Optional

M

MMMMM

M

M

M

M

MMMMO

All Payment Destinations

Enter 5 digit Company ID [this is your Web Business Banking (WBB) ID #. It can be locatedon the WBB Profile (Administration> View Company Profile)]Enter Name of CompanyEnter Company Contact NameEnter Date form was completed (MM/DD/YYYY)Enter Company Contact Telephone NumberName (s) and Signature (s) of the Authorized Signing Authority (s) of the Company

Enter the Template Identifier that you will use to select and identify the specific fixed templatein WBB Wire Payment ServiceChoose from drop down list -

Payment to Bank - the beneficiary is a bankPayment to Customer - the beneficiary is an individual or company

Choose from drop down list -TD Deposit Account - CAD or USD - payments destined for a TD BranchOther TD Account - payments destined for Global Operations Services DepartmentNon TD Account - Other Bank - all payments destined for a bank other than TD

Enter Beneficiary (Person or Company) NameNote: The Beneficiary name should be written in full for all payments. If the beneficiaryname exceeds the 35 character limit, please continue with the beneficiary name in theInstructions for Beneficiary FieldEnter Beneficiary Street AddressChoose from drop down listEnter Beneficiary CityIf Canada or US is Country chosen then choose Prov./State from drop down listIf Country other than Canada or US is chosen then enter Foreign Prov./State. Up to 11characters of a foreign province/state may be entered.

Field Name Mandatory/ Optional

All Payment Destinations

Bank Name

Street AddressCountryBank ID

Beneficiary AccountNumber

Note: In general,Beneficiary AccountNumbers should not includespaces or dashes

Payment CurrencyCityProv./State

Foreign Prov./State

M

OMM

M

MMM/O

O

TD Deposit Account

TD CANADA TRUST

Enter Branch address of bankCANADAEnter the Canadian ClearingCode or CC Code for TDBank

Format: CC0004XXXXX

Details:First 4 digits represents theBank Number and the last 5digits represent the branchtransit number

Enter 11 digit account (4digit transit and 7 digitaccount number) -- no spaces

Choose CAD or USD onlyEnter Beneficiary Bank CityIf Canada or US is Countrychosen then chooseProv./State from drop downlistN/A

Other TD Account

TD CANADA TRUST

sameCANADATDOMCATTTOR

Enter 13 digit account - nospaces

Choose from drop down listsamesame

N/A

Non-TD Account - Other Bank

Enter Bank name where beneficiaryaccount is heldsameChoose from drop down listFor Payments destined to Canada enter aCanadian Clearing Code or CC code

Format: CCXXXXXXXXXDetails: CC (9 digit CC Code)For USD Payments destined to U.S. aFed ABA number or Fedwire routing #is required

Format: FWXXXXXXXXXDetails: FW (9 digit ABA number)

For all other currency payments destined tothe U.S.:

Enter a SWIFT/BIC Code - 11 charactersFor Payments destined to the UnitedKingdom, Jersey C.I, Guernsey, C.I., Isle ofMan or Gibraltar enter a 6 digit Sort Code.

Format: SCXXXXXXDetails: SC (6 digit SC Code)For all other Foreign Destinations:

Enter SWIFT/BIC Code - 8 or 11 charactersEnter Account Number orInternational Bank Account Number(IBAN) - is provided by Beneficiary) Note:do NOT include the letters I B A N in thefield.

See Table 2 on page 6 for countries thatrequire an IBAN

If Beneficiary Bank is in Mexico - include18 digit CLABE number (for Payment toCustomer only )Choose from drop down listsamesame

If Country other than Canada or US ischosen then up to 11 characters of theForeign Prov./State may be entered

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Beneficiary Bank Details

Page 5 of 6

Field Name

Bank NameStreet AddressCountryBank IDCityProv./StateForeign Prov./State

Mandatory/Optional

MMMMMM/OO

Payment Destination - Non TD Account - Other Bank only

All fields are Mandatory if instructed to use an Intermediary Bank

Enter Bank nameEnter Bank AddressChoose from drop down listSee Tips for Bank ID under Payment Destination - Non TD Bank AccountEnter Intermediary Bank CityIf Canada or US is Country chosen then choose Prov./State from drop down listIf Country other than Canada or US is chosen then up to 11 characters of the ForeignProv./State may be entered.

Intermediary Bank Details:Note: Do not use unless specifically instructed to doso by TD Bank.

Field Name

Instructions forBeneficiaryInstructions for TD BankReason for Payment

Mandatory/Optional

M/O

OM/O

All Payment Destinations

Enter any instructions or reference for the Beneficiary.

Do not use this field unless specifically instructed to do so by TD BankMandatory - Include Reason for Payment for countries that require a reason - for Payment toCustomer only - see Table 1 on page 6

Instruction Details:

COUNTRY COUNTRY CODE

CONGO THE DEMOCRATIC CDEGYPT EGHUNGARY HUINDIA ININDONESIA IDIRAN IRISRAEL ILJORDAN JOMALAYSIA MYMAURITIUS MUPAKISTAN PK

COUNTRY COUNTRY CODE

POLAND PLRUSSIAN FEDERATION RUSAUDI ARABIA SASINGAPORE SGSOUTH AFRICA ZASRI LANKA LKSYRIAN ARAB REPUBLIC SYTHAILAND THTURKMENISTAN TMU.A.E. AEUKRAINE UA

COUNTRY COUNTRY CODE

ANDORRA ADUNITED ARABEMIRATES AEALBANIA ALAUSTRIA ATBOSNIA HERZEGOVINA BABELGIUM BEBULGARIA BGBAHRAIN BHSWITZERLAND CHCOSTA RICA CRCYPRUS CYCZECH REPUBLIC CZGERMANY DEDENMARK DKDOMINICAN REPUBLIC DOESTONIA EESPAIN ESFINLAND FIFRANCE FRUNITED KINGDOM GBGEORGIA GEGIBRALTAR GIGREENLAND GLGREECE GRCROATIA HRHUNGARY HUIRELAND IEISRAEL IL

COUNTRY COUNTRY CODE

ICELAND ISITALY ITKUWAIT KWKAZAKHSTAN KZLEBANON LBLIECHTENSTEIN LILITHUANIA LTLUXEMBOURG LULATVIA LVMONACO MCMONTENEGRO MEMACEDONIA MKMAURITANIA MRMALTA MTMAURITIUS MUNETHERLANDS NLNORWAY NOPOLAND PLPORTUGAL PTROMANIA ROSERBIA RSSAUDI ARABIA SASWEDEN SESLOVENIA SISLOVAK REPUBLIC SKSAN MARINO SMTUNISIA TNTURKEY TR

Reference

Table 1: List of Countries that require a reason for payment in the Reason for Payment Field

Table 2: List of Countries where IBAN (International Bank Account Number) is required - Enter IBAN in the

Beneficiary Account Number Field (Note: do NOT include the letters I B A N in the field).

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