Important rules  for submitting printed versions of online applications:

• Complete this Pre-Authorized Debit (PAD) insert ONLY IF YOU HAVE SELECTED PAD PAYMENTS ON THE APPLICATION. If you have chosen monthly PAD Payments, this insert MUST accompany the following applications for Empire Life policies/contracts, including any earlier versions, submitted on or after March 1, 2010:
  
  • Empire Class Segregated Funds Application - INP-0154 (10/08)
    
  • Empire Class Segregated Funds Application for a Tax-Free Savings Account - INP-0279 (01/09)
    
  If you are using an application with a 01/10 version date, you do not need to submit this insert.
   
• All trades must be submitted by wire via the FundSERV network.
   
• The original signed application, with cheque (if applicable), and any other supporting documentation must be received within T+3.
   
• The Investment Application forms part of the Investment Contract so your client must receive both. Make one copy of the original for his/her record and make one copy for your file.
   
• Please remember that delivery of the Information Folder and Policy Provisions for Empire Class Segregated Funds (INP-0176-ENG), the Information Folder Addendum/Policy Provision Endorsement, and Segregated Fund Highlights (INP-0099-ENG) to the client is required at the time of application for a new Contract.

Please click the “Accept” button below to confirm you have read and understood these requirements.

The PDF documents are provided for your convenience. Printed Applications are not valid if altered in any way from the original.