IPP Form

Client Information

First Name (required)

Last Name (required)

Home Phone

Cell (required)

Your Best Email (required)

I Grant Kevin Permission to Contact Me? YesNo

Gender: Prefer not to answerMaleFemale

Age:

Referred By:

Address

Please indicate your City and Province of residence as a minimum.

Street Address

City

Province

Country

Postal Code

Employment Information

Occupation

Employer

The actuary will need your S.I.N and date of birth.

Are you a connected person* with the company? yesno

Start date of service with the company

* A “connected person” is a person who holds, directly or indirectly (e.g. the spouse, father, mother, brother, sister, child or grandchild of a person who directly owns), at least 10% of the capital stock of an incorporated company or any other corporation related to it.

Company Information

Company Name

Street Address

City

Province

Country

Postal Code

Incorporation date

Fiscal year-end

Federal Business Number (BN)

Does a holding company manage the corporation? yesno

If yes, specify: