IMPORTANT INFORMATION TO NOTE BEFORE COMPLETING BENEFICIARY DESIGNATION FORMS

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1 Designating a beneficiary If the member wishes to designate one or more beneficiary(ies), the member can do so on their Naming or Substitution of Beneficiary Form by stating the beneficiary s full name and relationship to the member. The member can also designate a beneficiary by will or a subsequent beneficiary designation form. Forms must be completed, signed and dated by the member. The member must initial any changes or alterations to the designation, no matter how small. Correction fluid cannot be accepted. The signed witness on the form cannot be any of the designated beneficiaries. Forms must be sent to the NAV CANADA Human Resources office located at 77 Metcalfe (9 th floor), Ottawa, Ontario K1P 5L6. The member may designate as his/her beneficiary: any person; any registered charitable or benevolent organization or institution (name and registration number of the institution are required); any religious or educational organization (name is required); his/her estate; or a trust (in Quebec, the trust must be formally established). Revocable and irrevocable beneficiaries A revocable beneficiary means that the member is free to change the beneficiary designation at any time. A beneficiary designation is assumed to be revocable, unless specifically designated as irrevocable. There is an exception to this rule in Quebec: the designation of a legal spouse (married or civil union) as beneficiary is assumed to be irrevocable, unless specifically designated as revocable (please note that this exception does not apply to a common law spouse). An irrevocable designation means the member cannot change the designation without meeting specific requirements (see below). Changing a beneficiary designation If the beneficiary designation is revocable: a new Naming or Substitution of Beneficiary Form must be completed, dated and signed by the member and a witness. If the beneficiary designation is irrevocable: a new Naming or Substitution of Beneficiary Form must be completed, dated and signed by the member and a witness. In order for the member to change an irrevocable beneficiary or to change the current beneficiary designation from irrevocable to revocable, the member must also submit one of the following documents, depending on the situation: Consent by Beneficiary Form, signed by the irrevocable beneficiary, revoking their rights; or Divorce Certificate (in Quebec, a divorce granted after December 1st, 1982 automatically cancels the designation of the spouse as beneficiary, even if irrevocable); or Proof of death of the irrevocable beneficiary. More about beneficiary designations Designating one beneficiary: To designate one beneficiary, the member must complete the name and relationship of the beneficiary. Appointing a contingent beneficiary: A contingent beneficiary is the person designated to receive the proceeds if the primary beneficiary dies before the member. To appoint a contingent beneficiary, the member should complete the Contingent Beneficiary section of the Naming or Substitution of Beneficiary Form. Page 1 of 3

2 Designating more than one beneficiary: To designate more than one beneficiary, the member must indicate the name, relationship and percentage on the form for each. The total of the designated percentages must equal 100%. If percentages are not indicated, an even split will be made between beneficiaries. If a beneficiary predeceases the member, the deceased beneficiary s portion of the death benefit will be paid to the member s estate or to the contingent beneficiary(ies), if designated. Remaining percentages will be paid as listed on the beneficiary forms. EXAMPLE: Beneficiary % Beneficiary 1 98% Beneficiary % Beneficiary 2 1% Beneficiary % Beneficiary 3 1% Contingent Beneficiary or Estate If any of the beneficiaries predecease the member, their allocation will be paid to the Contingent Beneficiary (if designated) or the Estate. It will not be split between remaining beneficiaries. Contingent Beneficiary or Estate If Beneficiary 1 predeceases member, their 98% will be paid to the Contingent Beneficiary (if designated) or the Estate. It will not be split between remaining beneficiaries. Quebec residents: In the case of an even split between beneficiaries, the percentage allocated to the deceased beneficiary will be divided equally among the surviving beneficiary(ies). In the case of an uneven split, the deceased beneficiary s portion of the death benefit will be paid to the member s estate or to the contingent beneficiary(ies) if designated. Remaining percentages will be paid as listed on the beneficiary forms. EXAMPLE (Quebec Residents): Beneficiary % Beneficiary 1 98% Beneficiary % Beneficiary 2 1% Beneficiary % Beneficiary 3 1% If any of the beneficiaries predecease the member, their 33.33% will be split evenly between the remaining beneficiaries: Beneficiary 1 predeceases member, Beneficiaries 2 and 3 get 50% each. Contingent Beneficiary 1 or Estate If any of the beneficiaries predecease the member, their allocation will be paid to the contingent beneficiary (if designated) or the Estate: Beneficiary 1 predeceases member, Beneficiaries 2 and 3 get as indicated, and the 70% goes to the Contingent Beneficiary (ies) or Estate (as per completed form on file). Designating a minor child as beneficiary in Quebec: In Quebec, any amount payable to a minor beneficiary during his/her minority will be paid to the parent(s) or legal guardian on his/her behalf. If you wish to make provisions for an administrator or trustee to administer a minor child s money, you can do so in a will and designate the trustee as beneficiary. You may also want to consult with a legal counsel to determine if there are some estate planning steps you should take. Designating a minor child as a beneficiary in all other provinces: In all provinces other than Quebec, if the member designates a minor child as beneficiary, a trustee should be designated. If no trustee is named, proceeds may be paid into court. Page 2 of 3

3 Designating an estate: If you are designating your estate as beneficiary, the following should be considered: Insurance proceeds payable to the estate are subject to claims from creditors, whereas proceeds payable to a named beneficiary may, in some cases, be protected from creditors. In some instances, a will must be probated and the costs will vary from province to province. These costs are not incurred if proceeds are payable to a named beneficiary. Probate is not required for a notarial will in the province of Quebec. When no beneficiary has been designated: Proceeds will be paid to the member s estate. A properly constituted and current will should be submitted with any claim to avoid delays in processing with the executors or liquidators of the estate. Please remember: Sign each page of the beneficiary form Witness cannot be one of the named beneficiaries. Page 3 of 3

4 Basic Life Insurance (Group Policy #101198) Naming or Substitution of Beneficiary Original Designation Amended Designation Please Print Member Information Family Name Given Names Employee Number Full Residential Address Date of Birth (DD MM Marital Status single married common-law Residential Telephone Number Gender Male separated divorced w idow ed Beneficiaries - You may designate as your beneficiary: any person(s) any registered charitable or benevolent organization or institution (name and registration number of the institution are required) any religious or educational organization (name is required) your estate - You may change your beneficiary(ies) at any time while you are covered under this plan, subject to the legislation applicable to you in your province of residence. - A naming of beneficiary takes effect on the date this form is signed. However, Human Resources must receive this form prior to your death. - If more than one beneficiary is named, benefits will be payable in equal shares, unless you specify otherwise in the space provided. - If you require more space to enter your beneficiaries, please attach a sheet listing the information requested below for each beneficiary. I have attached a separate sheet indicating my additional beneficiaries. Female Please indicate below whether you designate your beneficiary as a revocable beneficiary or as an irrevocable beneficiary. This is a revocable designation of beneficiary. This is a irrevocable* designation of beneficiary. *An irrevocable designation cannot be changed unless you obtain a written authorization from your beneficiary. FOR QUEBEC RESIDENTS, as per Quebec legislation, the designation of your beneficiary is irrevocable unless otherwise specified (by checking off Revocable ). If left silent by not selecting one or the other, then it is irrevocable and written authorization will be required. Beneficiary Information Relationship to Member Relationship to Member Relationship to Member Relationship to Member Organization or Institution Name Institution Registration No. Telephone Number Estate Trust Member s Signature Date (DD MM Page 1 of 2 Version Date: April 2015

5 Contingent Beneficiary If there are no surviving beneficiaries at the time of my death, I declare that the following Contingent Beneficiaries shall receive the proceeds. If there are no surviving Contingent Beneficiaries at the time of my death, the proceeds shall be paid to my estate. I revoke all previous Contingent Beneficiary appointments. Relationship to Member Relationship to Member Relationship to Member Organization or Institution Name Institution Registration No. Telephone Number In Quebec, if you name your legal spouse (married or civil union) as the beneficiary, this beneficiary will be irrevocable unless you check the revocable box above. Trustee Clause Not Applicable to Quebec Residents If you appoint a minor beneficiary, complete this section. See below for age of majority by province/territory. I hereby nominate and appoint (full name), residing at (full residential address and telephone no.) my (relationship to you) if living, to receive and disburse any monies payable under the NAV CANADA Basic Life Insurance Plan, to my beneficiary(ies) during minority, and any payments made to the said trustee shall discharge NAV CANADA and its insurers to the extent of such payment. Quebec Residents Only Benefits payable under this plan to a beneficiary who, at the time payment is to be made, is a minor or lacks legal capacity, will be paid to his/her tutor(s), unless a valid trust has been established for the benefit of the beneficiary, by Will or by separate contract, to receive any such payment and NAV CANADA and Sun Life have been provided notice of the trust. If a valid trust has already been established, designate the trust as the beneficiary on this form. Before designating a trust, you should seek legal advice. Collection, use, and disclosure of your personal information I agree that only those employees who have a job-related need to do so are authorized to collect and/or use my personal information. I understand that the above personal information may be used for the purpose of administering NAV CANADA's Basic Life Insurance Plan, or as may be required by law. NAV CANADA agrees to protect and maintain the confidentiality of my personal information through appropriate security measures and safeguards. I understand that I may correct any of my personal information where it has been properly identified as incorrect. I further understand that NAV CANADA may engage the services of external providers and/or contractors that may require access to my personal information. NAV CANADA ensures all such parties enter into confidentiality agreements to protect and appropriately safeguard my personal information. Signatures Member Signature Date (DD MM Witness Signature Date (DD MM Member Name (Print) Witness Name (Print) Signed at: (City) in the province/territory of:. FOR HUMAN RESOURCES USE ONLY Verified By Date Received (DD MM Date Entered (DD MM Age of Majority Province/Territory 18 Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Prince Edward Island 19 British Columbia, Yukon Territory, Northwest Territories, Nunavut, Newfoundland and Labrador, New Brunswick, Nova Scotia Forward completed form to: NAV CANADA HR Records, 77 Metcalfe Street, Ottawa, Ontario, K1P 5L6. Confirmation of Receipt: You will receive a signed copy of this form confirming receipt of your completed form. Page 2 of 2 Version Date: April 2015