Purchase and Redemption Request

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Assante Wealth Management (Canada) Ltd.Purchase and Redemption Request

ASSANTE TYPE:

c Cash c Margin c RRSP c Spousal RRSP c LIRA c Locked-In RRSP c RRIF c Spousal RRIF c LIF c LRIF c RESP c TFSA c RLIF c RLSP

ASSANTE ACCOUNT(S) #: c CLIENT NAME c NOMINEE c OTHER ___________________________________

c ASSANTE CAPITAL MANAGEMENT LTD. c ASSANTE FINANCIAL MANAGEMENT LTD.

CLIENT INFORMATION (Please complete all sections.)

Last Name of Client – (Check one) c Mr. c Mrs. c Miss c Ms. c Dr. First Name & Initial(s)

c Joint Application With (Please complete the additional client information.)

Last Name of Joint Applicant – (Check one) c Mr. c Mrs. c Miss c Ms. c Dr. First Name & Initial(s)

PURCHASE INSTRUCTIONS (NOTE: Do not combine client name purchases for different fund companies on the same form.)

Fund No. Fund Name Existing Fund Acct. # Option/Sales Charge Amount ($) WO#

Source of funds: c Cheque c Cash c Transfer TOTAL ($)

Dividends: c Reinvest c Cash

REDEMPTION INSTRUCTIONS This is my authority to redeem: (NOTE: Do not combine client name redemptions for different fund companies on the same form.)

Fund No. Fund Name Existing Fund Acct. # Option/Sales Charge Amount ($) Net/Gross of DSC fee

WO#

Net proceeds to client will be minus applicable withholding taxes and any withdrawal fees on Registered Accounts. Total Gross ($) (before fees & taxes)

Are there any outstanding share certificates for this account? c Yes (Please attach share certificates in order to process the redemption.) c No

Are there any hypothecation or loans? c Yes (Include Lender’s Approval) c No

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WITHDRAWAL INSTRUCTIONS

Net proceeds to client will be minus applicable withholding taxes and any withdrawal fees on Registered Accounts.

Total Gross (before taxes and fees): $ ________________________

Net to Client: $ ________________________

c Specified taxes _________% or ______________amount c Default taxes

c Please leave cash in account (for Nominee Only)

c Transfer cash to Assante account #:

c Please make funds payable to Client and: c send cheque by mail c EFT to client bank account (Please attach the void cheque and complete the below.)

c Please make cheque payable to (Send cheque by mail):

c Special Instructions:

HOW WAS THE BANKING INFORMATION RECEIVED? (Mandatory)

c In person c Via phone c On file c *Electronic (email/fax)

*If electronic please initial the disclaimer (right) or confirm via email.

I, _______________________________________, have verbally confirmed the banking information with the client either on the phone or in person.

*Initials X

NOTE: Assante policy requires that all banking information received through electronic means be verified with the client verbally either in person or on the phone.

CLIENT AUTHORIZATION (Please read carefully before signing.)

I/We, the Client(s), acknowledge and confirm I/we understand the charges, terms, conditions, and provisions stated in the fund facts, which apply to the transaction(s) for which this application is made, and I/we have received the current fund fact document(s) of the above fund(s) from my/our Representative. If a purchase is made with borrowed funds, I/we confirm that I/we have received, understood and signed a Leverage Analysis and Disclosure Form.

Signature Guarantee

Name of Client Signature X

Date MM / DD / YYYY

Name of Joint Applicant Signature X

Date MM / DD / YYYY

Name of c Advisor or c Servicing RR/IR (1) Signature X

Date MM / DD / YYYY

Name of c Advisor or c Servicing RR/IR (2) Signature X

Date MM / DD / YYYY

Name of c Advisor or c Servicing RR/IR (3) Signature X

Date MM / DD / YYYY

Name of c Advisor or c Servicing RR/IR (4) Signature X

Date MM / DD / YYYY

I/we, the representative(s), or other licensed individual(s) acknowledge and confirm I/we have fully stated to the above-named client(s) the charges the client(s) will be required to pay, directly or indirectly, in respect of the purchase or redemption, or reasonable estimate if the actual amount of the charges is not known, as well as terms, conditions, and provisions which apply to the transaction(s) for which this application is made and I/we have delivered or caused to be delivered the current fund fact document(s) of the above fund(s) to the client(s).

FOR DEALER USE ONLY

Name of Advisor Dealer Code Rep Code

2 Queen Street East, 20th Floor, Toronto, Ontario M5C 3G7 Telephone: (416) 681-1038/1-800-268-3200 Fax:1-800-410-4505 Email: service@assante.com

1705-0915 – AWM_1321_E (11/17)