REGISTERED RETIREMENT INCOME FUND (RRIF)

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BRA1537A (2015-11)

MONTREAL SALES OFFICE

Tel.: 1-855-425-0904

Fax: 1-866-606-2764

ONTARIO, WESTERN AND ATLANTIC

CANADA SALES OFFICE

Tel.: 1-888-429-2543

Fax: 416-928-8515

QUEBEC CITY SALES OFFICE

Tel.: 1-888-900-3457

Fax: 1-866-559-6871

SSQ CLIENT SERVICES

P. O. Box 10510, Stn Sainte-Foy

Quebec QC G1V 0A3

1245 Chemin Sainte-Foy, Suite 210

Quebec QC G1S 4P2

Tel.: 1-800-320-4887

Fax: 1-866-559-6871

ssqir@ssq.ca

ssq.ca

Advisor’s document

Investment

REGISTERED RETIREMENT

INCOME FUND (RRIF)

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IS YOUR CLIENT READY

FOR RETIREMENT?

When retirement finally arrives, a considerable number of

important decisions about such things as living arrangements

and new leisure activities, as well as their priorities typically need

to be made. But one of the first decisions your clients will need

to make concerns their financial future. What should be done

with the savings accumulated over the years in retirement savings

plans?

There are numerous financial products and options available

that will modify the nature of the portfolio. The choices that are

made ultimately depend on the personal asset management

style of each investor.

If your clients want to retain control over their investments, the

Registered Retirement Income Fund (RRIF) and its locked-in

versions (LIF, LRIF and PRRIF) are ideal choices.

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2 RRIF

RRIF PLANS: FOR MAXIMUM FLEXIBILITY

The Registered Retirement Income Fund (RRIF) and its locked-in versions (LIF, LRIF and PRRIF) are registered retirement

products that allow for the reinvestment of equity while also offering various benefit options. Investors receive regular

income payments while maintaining the opportunity, in some cases, to withdraw additional amounts as needed.

In addition, RRIFs provide investors with a great deal of flexibility so that they can review their investment portfolio mix

from time to time to make sure it corresponds to their financial objectives.

PRINCIPAL FEATURES OF SSQ RRIFs

RRIF

Locked-in RRIF (LIF, LRIF and PRRIF)

Source of

investment

amounts

• Registered retirement savings plan (RRSP)

• Non locked-in amounts from a simplified

pension plan (SIPP) or registered pension

plan (RPP)

• Deferred profit sharing plan (DPSP)

• Other RRIF

• Registered pension plan (RPP)

• Locked-in amounts from a simplified

pension plan (SIPP)

• Locked-in RRSP (LIRA, LRSP, RLSP)

• Other locked-in RRIF under the same

legislation

Taxation

Invested funds continue to generate a tax-free return

Payments are taxable

Minimum

Investment

$5,000 ($25,000 under the Select GIA)

Investment

options

• Full range of compound interest

on higher amounts

GIAs

—both short and long term—with enhanced rates

• Some 50

SSQ Guaranteed Investment Funds (GIF)

managed by renowned money

managers, several of whom are pension plan managers

Guarantee

options for

segregated

funds

• Basic guarantee (75% at maturity, 75% upon death)

• Enhanced guarantee (75% at maturity, 100% upon death)

• Optimal guarantee (100% at maturity, 100% upon death)

For more information about the guarantee options, please refer to the Information Folder.

Payment

options

• Minimum income

_{• Fixed income}

• Level income

• Minimum income

• Fixed income

• Level income (FRRP)

• Maximum income (LIF or LRIF)

Bank deposits

• Direct deposit in the client’s bank account on the day and frequency chosen (weekly,

every two weeks, monthly, every two months, quarterly, semi-annually or annually)

• Minimum transaction amount is $100

Investment

withdrawal

order

• All investment withdrawal orders specified by investors are possible, whether it be from

redeemable GIAs, SSQ GIFs or both

Lump-sum

redemptions

Unscheduled lump-sum redemptions are permitted at any time provided that the investment

vehicle selected allows it (redemption fees may apply)

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Different Benefit Options

DIFFERENT BENEFIT OPTIONS

Different options allow investors to withdraw funds from their RRIF or LIF

1

_:

Minimum income:

The minimum income RRIF and locked-in RRIF allow your clients to retain as much tax-sheltered

income as possible for future needs. They need only withdraw the minimum income prescribed by law

2

_.

Fixed income:

The fixed income RRIF and locked-in RRIF provide income stability. The investor determines the amount of

the annuity (greater than the minimum annual amount) according to different criteria (such as needs, type of investment,

etc.). LIF and LRIF payments are subject to the maximum amounts permitted by law

2

_.

Level income (RRIF or PRRIF):

With the level income RRIF or PRRIF, investors can spread out total income over a fixed

period of time. This means that their income is distributed equally over the desired number of years

3

_.

Maximum income (LIF or LRIF):

The maximum income LIF or LRIF allows investors to withdraw the maximum amount

of income possible to meet current financial needs. Your clients can therefore withdraw the maximum income prescribed

by law

2

_.

Below is an example of a person retiring at age 65 who invests $100,000 for a 5-year term

4

_{. The average monthly payments}

and residual value at the end of five years are as follows:

Average monthly

payment

Residual value

after 5 years

Minimum Income

$355

$93,000

Fixed Income

$500

$83,600

Level Income (RRIF or PRRIF)

$1,790

$0

Maximum Income (LIF or LRIF)

Manitoba, Quebec and Nova Scotia

$567

$79,200

British Columbia, Alberta, Ontario, New Brunswick and Newfoundland and Labrador

$582

$78,200

Federal

$453

$86,600

1

_{Subject to the limits stipulated in the}

_{Income Tax Act}

_{and applicable pension legislation.}

2

_{The minimum and maximum annual income rules are established at the beginning of the year as a percentage of the residual value of the RRIF}

or the locked-in RRIF and are based on the age of the annuitant or spouse. In some jurisdictions, it is possible for anyone retiring before age 65

to ask for a temporary income that will allow them to withdraw amounts higher than the maximum income before age 65.

3

_{To request the level income, please check the “Other” box in section 8C of the application form and indicate the income duration.}

4

_{The examples provided are valid as of January 1, 2015, and are based on the assumption of a 3% rate of return, whether placed in GIAs or in funds.}

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4 RRIF

INVESTMENTS THAT MATCH THE CLIENT

The RRIF allows clients to choose the mix of investment products that will best meet their retirement needs and specific

objectives. They may invest in the investment funds (SSQ GIFs), guaranteed interest accounts (GIAs), or a combination

of the two, in order to continue to obtain a return on investment even if the withdrawal period has begun.

INVESTMENT OPTIONS

Guaranteed

interest

accounts

(GIAs)

• Redeemable GIA Option 1

• Redeemable GIA Option 2

• Non-redeemable GIA

Non-redeemable GIAs are not eligible for periodic or lump-sum redemptions.

• High Yield Account

• Redeemable or non-redeemable Select GIA

SSQ

Guaranteed

Investment

Funds (GIF)

The complete range of SSQ GIFs is offered, including many portfolio funds and alternative

asset classes.

WHICH GUARANTEED INTEREST ACCOUNT (GIA) TO CHOOSE?

Depending on the income needed every year, the GIAs offer different possibilities.

Rates offered are posted every week on our Web site.

The GIAs are automatically renewed at maturity offering the same features and the same duration, unless instructed

otherwise.

Redeemable

GIA Option 1

• With the redeemable GIA Option 1 cash redemptions are possible for an annual total

up to 20% of the market value of redeemable GIAs held in the contract as at last December 31

without redemption fees

• Additional redemptions may be made, but redemption fees will apply (market value

adjustment), unless the GIA has come to term

• Interest rates applied to these GIAs are usually higher than those in Option 2

Redeemable

GIA Option 2

• With the redeemable GIA Option 2

annual total of more than 20% of the market value of redeemable GIAs held in the contract

planned periodic

cash redemptions are possible for an

as at last December 31

without redemption fees

• Additional

unscheduled lump-sum

redemptions may be made, but redemptions fees will

apply (market value adjustment), unless the GIA has come to term

• Interest rates applied to these GIAs are usually lower than those in Option 1

Non-redeemable

GIAs

• It is possible to have non-redeemable GIAs and thus obtain a higher interest rate, but these

GIAs

cannot be

redeemed (periodic or lump-sum redemptions)

High Yield

Account

• The High Yield Account is a redeemable investment which works as a savings account.

Interest rates are usually higher than for traditional savings accounts

• This is a great alternative to the money market fund for funds awaiting investment

Select GIA

• For GIAs of $25,000 and more, you can offer your clients an enhanced rate in return for a

reduced commission. Certain conditions apply

• The Select GIA may be redeemable or non-redeemable, but the latter cannot be redeemed

as a periodical or lump-sum redemption

• For the redeemable Select GIA, Option 1 and Option 2 described above are also offered

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WHICH SSQ GUARANTEED INVESTMENT FUND (GIF) TO CHOOSE?

The client may choose from among the wide range of SSQ GIFs, from income funds to specialty funds, and including

balanced funds, index and Canadian or foreign equity funds.

Income funds

Balanced funds including four SSQ Strategy GIFs and four SSQ Celestia GIFs

Canadian equity funds

Foreign equity funds

Specialty funds including global infrastructure and real estate

Index funds

For each of the SSQ GIFs, the investor may withdraw up to 20% of the fund’s market value invested with the back-load

sales charge option

with no redemption fees

1

_.

1

_{Subject to the limits on revenue stipulated in the}

_{Income Tax Act}

_{and applicable pension legislation. For further details about the calculation of}

this exemption, please refer to the

Information Folder

.

CHOICE BASED ON THE INVESTOR PROFILE

If clients do not wish to spend a lot of time monitoring the markets and their portfolio, or if they

aren’t familiar with investing, then the diversified funds like our

SSQ Strategy GIFs and SSQ

Celestia GIFs

are an excellent way of hedging against market risks. These products are backed

by a team of professional managers with a variety of investment styles who invest in a wide

range of products and who monitor these investments.

Each SSQ Strategy GIF and SSQ Celestia GIF is designed to cater to a specific investor profile and

includes a combination of specially selected investment vehicles and fund managers. These

funds allow investors to automatically benefit from an asset mix carefully selected by expert fund

managers to diversify each portfolio and maximize long-term investment growth.

The Investor profile will help guide your clients through the world of investment funds and help

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6 RRIF

DOCUMENTS AND ADMINISTRATION

APPLICATION FORM

On the application form for the regular product (FRA641), investments may be selected in Section 7, including the

redeemable Option 1 and Option 2 GIAs:

Section 1: Type of Contract / Plan

In the absence of any choice, the contract will be designated a “client” type contract by default. Client (Choose one plan only. Refer to the “General Information and Instructions for Completing Application Form” section for more details about the plans available.)

SSQ RSP SSQ Spousal RSP1 _{SSQ NRSP}_{(Non-Registered)} _{SSQ RIF}2 _{SSQ Spousal RIF}1, 2

SSQ LIRA3 _{SSQ LIF}2, 3 _SSQ_PRRIF_{(Saskatchewan)}2 _{SSQ LRIF}_{(Newfoundland and Labrador)}2, 3 1_{Complete Section 3.} 2_{Complete Section 8. The Laddered GIA and the SSQ Equity GIA are not available for these plans.}

3_{Indicate pension legislation applicable to the plan and whether it is a restricted plan:}

Nominee Dealer or Nominee Intermediary SSQ NRSP Specify external plan:

Section 2: Investor

The investor must reside in Canada.

Last Name First Name Social Insurance Number

Y Y Y Y M M D D

Address (No.) Street Apt. Date of Birth

City Province Postal Code

Sex: Female Male Telephone (home) Telephone (office) Ext. Email Language: English French

Estate Planning: If you wish to designate a contingent investor (subrogated in Quebec), complete form FRA1781. (Option available for NRSPs)

Section 3: Other Parties to the Contract

Payer (Complete for a Spousal RSP or Spousal RIF)

Spouse (Complete only if under Section 8C, you request that minimum income payments for RIF, LIF, PRRIF and LRIF be calculated based on spouse's age.)

Co-investor (available for NRSP only) Sharing Ratio: Investor: % Co-investor: %

Legal Representative Guardian Curator Estate Executor Other (specify):

Y Y Y Y M M D D _{Sex: Female Male}

Date of Birth

If address is different from the investor's, please indicate it in Section 10. However, please note that SSQ sends contract-related information to the investor's address.

Section 4: Annuitant

For registered plans, the annuitant is the same person as the investor. For NRSP, the annuitant may be a different person than the investor. The annuitant must be a physical person and a resident of Canada, as required by law. In the absence of any instructions, the annuitant is the same person as the investor.

Y Y Y Y M M D D

Address (No.) (if different from that of the investor) Street Apt. Date of Birth Sex: Female Male

City Province Postal Code

Estate Planning: If you wish to designate a successor annuitant, please complete form FRA1781. (Option availablefor NRSPs and RIFs).

New Contract Modification / Addition to Contract Contract No.:

If requesting a modification or an addition, please indicate the contract number and complete only the sections to modify. Your contract information in other sections will remain unchanged. Also, please note that it is not possible to make changes to Sections 1, 3 and 4 and therefore SSQ will not take into account any information entered in those sections.

In this document, care has been taken to eliminate sexual stereotyping when making gender references.

Section 5: Beneficiary(ies) Designation

If not enough space is provided, use Section 10.

In the event of the death of the annuitant, the death benefit is payable to the beneficiary (ies) mentioned here below, or, in the absence thereof, to my estate. Should no choice be made, the beneficiary designation is revocable, except in Quebec, where the designation of the married or civil union spouse as beneficiary is irrevocable, unless the “revocable” box has been checked. A contingent beneficiary has no rights unless all primary beneficiaries are deceased.

Should the beneficiary be named irrevocably, he will be required to consent to any future beneficiary designation modification and for any withdrawal of sums. A minor child irrevocably designated cannot modify the irrevocable nature of the designation until he reaches majority. Should no choice be made, where the investor is a corporation, the investor will be the designated beneficiary.

Last Name, First Name**

Relationship to the Annuitant

(or in Quebec, relationship to the Investor) Order of Beneficiary

Revocability of

Primary Beneficiary _{Date of Birth}

(if minor)

Spouse*Un-married_Spouse Other

Primary Contingent

Revocable Irrevocable Sharing

Ratio (%)

N/A Y Y Y Y M M D D Y Y Y Y M M D D Y Y Y Y M M D D

*Spouse or civil union partner Civil unions are considered the same as marriage when contracted in compliance with prescribed rules before a competent officiant and registered with the provincial authorities.

**If you want the death benefit to be paid out in the form of an annuity, please complete form FRA1744.

Information about the Trustee (Does not apply in Quebec)

Complete this section only if the beneficiary is a minor. A trustee must be appointed to receive payment on behalf of a designated beneficiary who is a minor until the beneficiary reaches the age of maturity. In Quebec, payment will be made in the name of the minor beneficiary and sent to the beneficiary’s parent(s) or legal guardian.

Name of Trustee Relationship to Trustee

Section 6: Source of Monies

Loan Lender's Name: Cheque in the amount of $ made out to SSQ, Life Insurance Company Inc.

Name of Institution

Transfer of $ from outside source (enclose appropriate form)

Transfer of $ from an SSQ contract

Section 7: Lump-Sum Investment

Only one guarantee option is permitted per application. Refer to Section 6.4 of the Information Folder for age limits for subscribing and contributing. For the GIA, if instructions are incomplete, or if amounts are less than the minimum permitted, the amounts will be invested in a daily interest investment vehicle.

SSQ GIF Minimum $400 High-Yield Account Fund code1

MANDATORY ($ or %) (mandatory if FundSERV)Wire order No. Amount of $

SSQ GUARANTEED INVESTMENTS (GIA)

Type of GIA ($) Term Interest_{(S or C)}2 Redeemable_{(Y or N)} 3 Options4,5

Regular Min. $400 1 to 120 months N/A

Regular

(if RRIF, LIF, PRRIF and LRIF) Min. $400 1 to 120 months C Y

Laddered Min. $5,000 3,5,7,10 years N/A

Total: Select Min. $25,000 12 to 120 months

OR

SSQ EQUITY GIA (a separate application form is required) Contribution deadline is December 31 of the year the annuitant turns age 61. Minimum $5,000

Please select allocation option:

SSQ Equity GIA (40% Fund) or SSQ Equity GIA (60% Fund)

In the absence of investment instructions, the SSQ Equity GIA (40% Fund) option will automatically be selected. Redeemable 120-month term GIA with compound interest. Income will be reinvested.

For the portion invested in Funds, please indicate below the desired allocation (total should equal 100%). The applicable guarantee for this product is 100% at maturity (10-year term) and 100% at death.

Fund code1 _(MANDATORY) _(%)

Total:

For NRSP only (applies only if the income for the fund(s) purchased is distributed.) Please refer to Fund Facts. Payment of income is available only if the total distribution per fund is at least $100. Disposal of income (If no choice is made, income will be reinvested.):

Reinvested in the same fund OR Paid out by direct deposit (MANDATORY: Attach a personal cheque specimen marked “VOID”)

1_{The first digit of the fund code indicates the guarantee selected; the second represents the sales-charge option and the three last ones correspond to the fund number. Please note that funds}

offered in the SSQ Equity GIA have separate codes. Please ensure that the fund code corresponds to the desired investment. In the absence of choice for the first two digits, the basic guarantee and no-load sales-charge option (Mode A) will be selected.

2_{S = simple interest; C = compound interest (Simple interest terms are available for the NRSP only. For SSQ Guaranteed Investments with simple interest (S), income is paid annually by direct}

deposit. In the absence of choice, compound interest will be selected).

3_{Y = yes; N = no (In the absence of choice, the SSQ Guaranteed Income is redeemable).}

4_{Option 1: Exemption of redemption fees up to 20% of the market value of redeemable GIAs held in the contract. In the absence of instructions, Option 1 will be used.}

Option 2: Exemption of redemption fees on selected cash payments for the purchase of redeemable GIAs (at least 20% of the market value of redeemable GIAs held in the contract).

5_{For Select GIAs, the option selection is available for a redeemable investment only, and only for}_{RIFs, LIFs, PRRIFs and LRIFs}_.

Reserved for SSQ use only

SSQ FINANCIAL GROUP – CLIENT SERVICES: 1-800-320-4887

FRA641A (2015-11) _{FRA641A (2015-11)}

Reserved for SSQ use only

Contract No.

_{SSQ COPY}

_XXX000XXX

_{SSQ COPY}

_XXX000XXX

4_{Option 1: Exemption of redemption fees up to 20% of the market value of redeemable GIAs held}

in the contract. In the absence of instructions, Option 1 will be used.

Option 2: Exemption of redemption fees on selected cash payments for the purchase of redeemable GIAs (at least 20% of the market value of redeemable GIAs held in the contract).

Periodic payment terms and conditions are selected in Section 8:

Section 8: Pre-authorized Transaction Program

(MANDATORY: Attach a personal cheque specimen marked “VOID”)

A • Type of transaction (select one only) Subsection to complete Not available for

Pre-authorized Purchase Program (PPP) _{B and D} _{LIRA, RIF, LIF, PRRIF and LRIF Plans} Pre-authorized Redemption Program (PRP) _{B, E and C if RIF, LIF, PRRIF or LRIF} _LIRA Pre-authorized Transfer Program (PTP) B, D and E N/A

B • Payment frequency

(select one only)

Weekly Every two weeks Monthly Every two months Quarterly Semi-annually Annually Lump sum

Date of first payment: Y Y Y Y M M D D If no selection is made, in the case of RIF, LIF, PRRIF or LRIF the date will be December 1 of the year following receipt of the form. Otherwise, the date will be the first day of the month following receipt of the form.

C •RIF, LIF, PRRIF or LRIF payments (select one only)

Minimum Maximum (LIF or LRIF only) Fixed: $ Other: $ Amount: Gross Net

Document used to identify Investor or to validate the age: Birth Certificate Passport Driver’s Licence Other

Document Number: Delivery Location:

In the absence of any choice, the minimum income payments are calculated based on the age of the investor. If legislation permits, you may request that the minimum income payment be calculated based on the age of the spouse by checking this box: Calculate based on age of spouse (attach copy of birth certificate)

D • Purchase or Transfer “to” Laddered GIA, SSQ Equity GIA and Select GIA are not available.

SSQ GIF Minimum $40 / contribution High-Yield Account Fund code1

MANDATORY ($ or %) Amount of $

SSQ GUARANTEED INVESTMENTS (GIA) Minimum $400

Term ($) Interest_{(S or C)}2 Redeemable_{(Y or N)} 3

1 to 120 months

Total: $ 1 to 120 months

E • Redemption or Transfer “from”

SSQ GIF Minimum $100 / redemption SSQ GUARANTEED INVESTMENTS (Redeemable GIA ) Minimum $100 / redemption

Fund code1 _(MANDATORY) _($)* _($) _{GIA No.} _{GIA maturity date}

Y Y Y Y M M D D

Total:$ Y Y Y Y M M D D

* For the minimum/maximum income payment from a RIF/LIF/PRRIF/LRIF, the allocation must be in %.

1_{The first digit of the fund code indicates the guarantee selected; the second represents the sales-charge option and the three last ones correspond to the fund number. Please note that funds offered in the SSQ}

Equity GIA have separate codes. Please ensure that the fund code corresponds to the desired investment. In the absence of choice for the first two digits, the basic guarantee and no-load sales-charge option (Mode A) will be selected.

2_{S = simple interest; C = compound interest (Simple interest terms are available for the NRSP only. For SSQ Guaranteed Investments with simple interest (S), income is paid annually by direct deposit.}

In the absence of choice, compound interest will be selected).

F • Authorization

· I authorize SSQ, Life Insurance Company Inc. (SSQ) to debit my account according to my instructions, for pre-authorized and/or occasional or sporadic amounts or those specified in Section 8D and/or to deposit the fixed or variable amount based on the options selected in Sections 8C/8E, at the frequency selected in Section 8B.

· I authorize SSQ, Life Insurance Company Inc. (SSQ) to change the amount to be debited from my account and/or to be deposited in my account at my request.

· I authorize SSQ, Life Insurance Company Inc. (SSQ) to invoice me and debit any charges from my account if the pre-authorized debit payment cannot be processed as stipulated in this agreement. · I authorize the financial institution debit my account and/or to deposit into my account the previously specified amount. This authorization may be revoked at any time upon my written notice. This notice

must be sent to SSQ 30 calendar days prior to the next scheduled debit payment and/or deposit.

· I acknowledge receipt of a copy of this agreement and waive my right to receive any further notices in writing before the first pre-authorized debit payment and/or deposit, when a change is made by my request and when charges must be debited.

G • Right to recourse

I have certain rights to recourse should a debit not comply with this agreement. For example, I am entitled to receive a reimbursement of all unauthorized debit payments or those that are not in compliance with this authorization. For more information about my right to recourse, on how to obtain a sample cancellation form or any other information on my right to cancel a pre-authorized payment agreement, I may contact my financial institution or visit the CPA’s Web site at www.cdnpay.ca.

Y Y Y Y M M D D

Signature of Account Holder (mandatory) Signature of Joint Account Holder (if applicable) Date

Section 12: Authorizations and Signatures

Financial Security Advisor’s Declaration (signature of advisor is mandatory)

By signing here opposite, I acknowledge having read and accepted the Financial Security Advisor’s Declaration included overleaf. Investor (signature of investor is mandatory)

By signing here opposite, I acknowledge having read and accepted the Investor’s Declaration included overleaf.

For LIFs, PRRIFs and LRIFs for the provinces of Nova Scotia, Ontario, Alberta, Saskatchewan, British Columbia, Manitoba and Newfoundland and Labrador ONLY Spousal authorization for registration in locked-in plans

Do you have a spouse as defined under the pension legislation applicable to the plan? Yes No If yes, please provide the following information:

For the provinces of Nova Scotia, Alberta, Saskatchewan, British Columbia and Manitoba, it is not necessary for the spouse to sign this section. However, please attach the appropriate form indicating the spousal authorization or surrender in accordance with the pension legislation applicable.

For the provinces of Ontario and Newfoundland and Labrador, the spouse as defined under the applicable pension legislation must sign below to indicate authorization for registration in the locked-in plan.

Y Y Y Y M M D D

Signature of the Spouse Date

Signed at

City Province

Y Y Y Y M M D D

Signature of Advisor (mandatory) Date

Y Y Y Y M M D D

Signature of Investor (mandatory) Please print name in block letters Date

Y Y Y Y M M D D

Other Signature (where applicable – see Section 3) Please print name in block letters Date

Section 9: Identity Check, Verification of Third Parties and Declaration of Politically Exposed Foreign Persons (PEFPs)

Mandatory for NRSP only

Information about the investor:

Verification Document Document Number Province of Issue Detailed Occupation

Information about the co-investor:

Corporation or other entity: If the investor is a corporation or another entity (e.g., trust, association, etc.), complete form FRA1235 and provide the required documents.

What is the purpose and intended nature of the investment?

Short-term savings Frequent transactions Education Vacation fund Retirement savings Income

Emergency funds Inheritance Long-term investment Real estate purchase Succession plan Other ( )

Is there a third party to this contract, a third party who will pay for the contract, or have the use of the value of the contract or will have access to it?

No Yes If so, please fill out form FRA1234. If another party such as a representative, guardian, curator or a executor is indicated in Section 3, please fill out form FRA1234.

Complete if making lump-sum payment of $100,000 or more:

Does the investor, co-investor or one of their family members occupy or have occupied in the past a senior position of a government, political party, military, court or state-owned corporation of a country other than Canada? No Yes If so, please fill out form FRA1234.

Section 10: Additional Instructions

Section 11: Dealer/Advisor

Dealer’s Name (Agency) Financial Security Advisor’s Name

FundSERV or SSQ Code (if applicable): OR

Dealer Advisor Agency No. (SSQ) Advisor No. (SSQ) Reference Account No. (if applicable)

Additional Information for “Nominee/Intermediary” Type Contract (if applicable)

FundSERV Code: Intermediary’s Name Telephone Reference Account No. (if applicable) (Mandatory) Intermediary

Address (No.) Street City Province Postal Code

FRA641A (2015-11)

Reserved for SSQ use only Reserved for SSQ use only

SSQ COPY

XXX000XXX