Partners in Protection

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1 Partners in Prtectin Obtaining disability insurance is an equally imprtant purchase fr a medical student r an MD. If yu frecast yur anticipated incme, yu likely have millins at risk. Yet the purchase f a quality disability plan may seem a difficult prcess. Unlike a practicing physician, mst MD students dn t appreciate the impact that family histry, r a minr health change, can have n the ability t purchase disability insurance. Kirkham and Jack did recgnize this. Therefre, in cnsultatin with the CFMS, ur mandate was t create the mst cmprehensive disability insurance plan n the market, which ffered easy enrllment, substantial lifetime discunts, and prtectin that extended thrughut yur medical career. Over 50 years f experience wrking with thusands f physicians gave us the knwledge and negtiating visin t create a plan that nt nly met ur mandate, but changed hw the industry insured physicians. In 2003, the CFMS disability prgram was established, allwing a CFMS member the pprtunity t purchase disability prtectin fr their entire career. The prgram cntinues t be a leader in the marketplace. The Kirkham and Jack team take great pride in prviding hnest advice and assistance frm enrlment thrugh claims management. As the endrsed cnsultants f the CFMS (Canadian Federatin f Medical Students) ur crprate philsphy is Knwledge and Integrity equals Trust. T learn mre, details f the CFMS disability prgram are cntained within this brchure, as well as the Enrlment frm. T enrll in the CFMS Disability cverage, yu will need t cmplete the ne page enrlment frm enclsed, cmplete the Banking Authrizatin frm n the back f the enrlment frm, and submit bth alng with a depsit cheque payable t RBC INSURANCE fr the first mnth s premium. Once enrlled, YOU WILL RECEIVE FIVE MONTHS WAIVED PREMIUMS, with yur first autmatic draft starting after the waived premium perid. Cmpleted dcuments shuld be frwarded t: Kirkham & Jack 1660 Blair Rad Cambridge, Ontari N3H 4R8 Fr assistance please call r cntact Kirkham & Jack Inc.

2 CFMS Individual Disability Incme Prtectin Plan Designed fr Members f the Canadian Federatin f Medical Students The ONLY plan designed specifically fr Canadian medical students that des nt require evidence f health t enrll, guarantees yur premium/prvisins and has industry leading limits f $25,000 per mnth. > Simple ONE-PAGE enrlment frm with NO medical exam r bld test required > Up t a maximum mnthly benefit f $25,000 (nn-taxable) thrughut yur career withut medical evidence > Individually wned Cntracts f Insurance > Guaranteed premiums and prvisins t age 65 > HIV and hepatitis B and C cverage > Chice f Own Occupatin Definitin f Disability > Substantial premium reductins t age 65 AND five mnths f WAIVED PREMIUMS > Cverage can be cntinued beynd 65 Kirkham & Jack Inc. LES Financial Services This ffer is designed specifically fr CFMS Members in Partnership with Kirkham & Jack Inc., LES Financial Services, The Canadian Federatin f Medical Students and RBC Insurance.

3 Specifically designed t grw with yu thrughut yur career If anyne understands the vulnerability f gd health and the need fr persnal financial prtectin, it s medical prfessinals. Yu will be expsed t surrundings and risks the average persn simply desn t have t face in their day-t-day lives. Yet, during yur training, the cst f yur educatin may accumulate t a debt that exceeds the value f yur parents first hme. They wuldn t have cnsidered leaving themselves expsed t this risk by nt insuring. Why shuld yu? As a member f CFMS, we have specifically designed a prtectin plan that fcuses n yur current needs while prviding flexibility fr yur future requirements. The CFMS ffer is an individual disability incme prtectin plicy with full return-t-wrk benefits and with premiums and wrding that are GUARANTEED fr the life f the cntract. These guarantees ensure that any negative market trends wn t impact yur plan, a plan that prtects yur mst valuable asset yu. Flexible slutins t meet yur needs withut ever prviding evidence f health Chice f Enhanced r Specialty Prfessinal prgram > Bth plans ffer a mnthly benefit f up t $4,000 tax-free as a medical student, with benefits payable after a 90-day eliminatin perid. Yu may chse frm either the Enhanced r Specialty Prfessinal prgram. > Enhanced Prfessinal includes features that are unique t an individually wned cntract f insurance: prtectin against ttal disability, partial and residual disability benefits, a recvery benefit and a survivr benefit at the time f death t yur designated beneficiary. The plan als includes a cst f living feature (which helps prtect yu against inflatin while disabled), the Future Incme Optin (up t $25,000 mnthly benefit with n evidence f health t keep pace with rising incme), a health care rider (t prtect yu if yu becme HIV r hepatitis B/C impaired). > Specialty Prfessinal includes all f the features f Enhanced Prfessinal, but ffers yu an Own Occupatin Definitin f Disability. With this feature yu have the chice t wrk in a new ccupatin while ttally disabled and may be eligible t cntinue cllecting ttal benefits even if yu are earning incme frm this new ccupatin.

4 Frequently asked questins 1. Hw des this plan differ frm an assciatin-type plan? Assciatin-type plans are nt guaranteed. Features and premiums can change at any time withut cnsent frm insured members. In additin, many assciatin-type plans include a limitatins prvisin, allwing the insurer t reduce benefits. In essence, yu may be paying fr a benefit yu may nt be receiving. Under the CFMS ffer, there is n such limitatin clause. Premiums and cntract wrding are GUARANTEED t age I will be receiving mandatry, prvince-specific disability cverage when I start residency. Hw des this impact my plan? Benefits under the CFMS ffer are paid regardless f yur residency cverage. It is recmmended that yu have sme privately wned disability prtectin t supplement a resident plan and fr yur pst-residency needs. 3. If I chse the Enhanced Plan nw, can I btain the Specialty Plan later? Yes, at any time during yur training r within 180 days f cmpleting residency r fellwship, yu may btain the Own Occupatin feature in the Specialty Prfessinal Plan, and n evidence f health will be required. 4. Hw des the Future Incme Optin (FIO) benefit me? This is ne f the mst imprtant features t have. Yu will be ffered an pprtunity t increase yur cverage annually. Under the CFMS ffer, we have specifically designed the FIO t allw yu t increase yur cverage up t a maximum f $25,000 tax-free, withut ever having t prvide medical evidence. Financial prf is required t supprt the increase. 8. Is the CFMS Disability Incme Prtectin Plan different frm the current plan available t physicians n an individual basis? Yes, the CFMS plan is a special ffer with premium reductins available t CFMS members nly. It uses a simple ne-page applicatin, and medical evidence is nt required. The main cverage terms and prvisins are the same. 9. Des the premium reductin apply nly t my riginal purchase f cverage? N, yu will be ffered a premium reductin n insurance purchased tday AND any cverage purchased in the future (using the Future Incme Optin rider). As mst cverage will be added pst residency, this feature will increase in value ver time. 10. Can I chse a shrter eliminatin perid? Yes, hwever, a fully cmpleted applicatin and evidence f health is required. 11. When shuld I apply fr disability incme prtectin cverage? Nw. Yu shuld apply fr cverage while yu are a current CFMS member and can qualify fr this unique ffer. 12. Hw des the 24-mnth pre-existing clause wrk? If yu had a pre-existing cnditin within the 24 mnths prir t the cverage being in frce and the disability was related t a pre-existing cnditin and began within the 24 mnths after the cverage was in effect, then that cnditin wuld nt be cvered. 5. Hw much FIO may I take? The size f the Future Incme Optin (FIO) in bth the enhanced and specialty plan is $1,000 per mnth. This can be increased at the end f yur residency up t $3,000 per mnth withut medical evidence. 6. Is cverage prtable? Yes, cverage can be carried anywhere in the wrld. Membership in the CFMS is nt required in the future. 7. If I am healthy and submit medical evidence, are my rates less expensive? N, rates are based n yur age, gender, smking status and the CFMS premium reductin. If yu apply fr an individual disability plicy with RBC Insurance utside f this ffer, yu will frg the CFMS premium reductin and yur premium rate will be based n the full underwriting f yur applicatin.

5 Buying yung means lng-term savings The yunger yu are when lcking int GUARANTEED rates, the mre savings yu may enjy lng term. Premiums DO NOT increase as yu age, and they are guaranteed t age 65. Mnthly benefit available: 1st and 2nd years: up t $1,500 3rd year: up t $2,500 Graduating: up t $4,000 MALE NON SMOKER A B C D AGE Enhanced Prfessinal Specialty Prfessinal Future Incme Optin (Enhanced) Future Incme Optin (Specialty) 25 and under $6.89 $8.00 $4.13 $ $7.09 $8.23 $4.25 $ $7.25 $8.43 $4.36 $ $7.44 $8.64 $4.47 $ $7.66 $8.89 $4.60 $ $7.93 $9.20 $4.76 $ $8.24 $9.55 $4.94 $ $8.57 $9.93 $5.15 $ $8.96 $10.39 $5.37 $ $9.38 $10.88 $5.63 $ $9.84 $11.41 $5.90 $6.85 Abve age 35 * FEMALE NON SMOKER A B C D Frmula: AGE Enhanced Prfessinal Specialty Prfessinal Future Incme Optin (Enhanced) Future Incme Optin (Specialty) 25 and under $10.37 $12.04 $6.22 $ $10.88 $12.66 $6.53 $ $11.31 $13.13 $6.78 $ $11.73 $13.61 $7.04 $ $12.23 $14.19 $7.34 $ $12.82 $14.87 $7.69 $ $13.48 $15.62 $8.09 $ $14.21 $16.46 $8.53 $ $14.77 $17.12 $8.86 $ $15.32 $17.76 $9.20 $ $15.87 $18.41 $9.53 $11.05 Abve age 35 * ( x ) + = per mnth. (A r B x Number f Units) + (C r D) = Mnthly Premium Example f this calculatin fr a male, age 26, in his secnd year, wh purchases a $500 a mnth Enhanced Plan benefit: ($7.09 x 1) + $4.25 = $11.34 per mnth. Insurance age is yur actual age within the next six mnths. Premiums are based n 1 unit = $500 per mnth. * Premiums fr age 35+ r smker, please cntact yur brker.

6 GROUP NAME DATE OF BIRTH SOCIAL INSURANCE NUMBER SEX LANGUAGE Canadian Federatin f Medical Students M Day Yr English NAME OF PROPOSED INSURED FIRST MIDDLE LAST French ADDRESS CITY PROVINCE POSTAL CODE address telephne number ALTERNATE CONTACT NUMBER (PARENT, SIBLING, SPOUSE) FULL NAME OF BENEFICIARY FOR SURVIVOR BENEFIT RELATIONSHIP TO INSURED UNIVERSITY NAME MEDICAL SCHOOL GRADUATION YEAR QUESTIONNAIRE: 1. Fr the perid f time cmmencing 180 days prir t the date f this enrllment frm, are yu nw r have yu been unable t wrk cntinuusly n a full-time basis in the usual and custmary manner perfrming all f the duties f yur ccupatin and/r have yu been hmebund and/r hspitalized due t an accident r sickness? 2. D yu currently have the lss f: yur pwer f speech, r yur hearing in bth ears, r sight in bth eyes, r the use f bth hands, r the use f bth feet, r the use f ne hand and ne ft? 3. Have yu used tbacc prducts including any smking cessatin prducts within the past 12 mnths? 4. Has an individual, grup r assciatin insurance cmpany ever declined yu disability cverage? Details t YES answers: Yes N # # OTHER DISABILITY INSURANCE IN FORCE OR APPLIED FOR (INCLUDING INDIVIDUAL, GROUP OR ASSOCIATION) IF NONE, INDICATE NONE COMPANY WAITING PERIOD BENEFIT PERIOD BENEFIT AMOUNT TAXABLE? TYPE -ID/GROUP/ASSOC. REPLACING EFF. DATE OF LAPSE PLAN NAME WAITING PERIOD BENEFIT PERIOD RBC INSURANCE APPLIED FOR BENEFIT AMOUNT ENHANCED r SPECIALTY Circle One 90 days T age 65 $ BROKER S REMARKS: BENEFITS INCLUDED COLA FIO ($1,000) HCR EFFECTIVE DATE OF COVERAGE REQUESTED MONTH: PAC/VOID/Depsit Required payable t RBC Life Insurance Cmpany. It is understd and agreed as fllws: 1) I have read the freging statements and answers. They are true and cmplete. They are part f this applicatin and any individual plicy issued as a result. 2) I will discntinue any plicy(ies)/cverage shwn t be discntinued r replaced. RBC Life Insurance Cmpany ( RBC Life ) will rely n such answers in determining the amunt, if any, f insurance it will issue. 3) N agent r brker has authrity t waive the answer t any questin, t determine insurability, t waive any rights r requirements r t make r alter any cntract r plicy. 4) The insurance applied fr will nt becme effective unless the issuance f the plicy and payment f the first premium ccur while the freging statements and answers remain the same. 5) Any plicy issued as a result f this frm shall becme effective (a) n the Date f Issue f the plicy, if applicable; and (b) therwise n the effective date f my grup insurance. 6) Acceptance f any plicy issued as a result f this enrllment frm will ratify my acceptance f any differences in the terms f cverage between the plicy wrding and as stated in this frm. 7) RBC Life shall nt be liable fr any claim n accunt f disability cmmencing prir t the effective date f insurance. Nt withstanding any interim premium payments, n temprary r cnditinal insurance is being prvided t me. 8) Any plicy issued as a result f this applicatin shall be subject t a grup/assciatin ffset amendment and a pre-existing cnditins amendment (which cntains a cverage exclusin based n my pre-existing health), if applicable. Als, if individual cverage is part f a Wage Lss Replacement Plan, the plicy is subject t a Wage Lss Replacement Amendment. 9) I hereby authrize RBC Life t use my Scial Insurance Number specifically fr any tax reprting purpses. 10) I acknwledge receipt f the Ntice regarding the MIB, Inc. 11) I authrize RBC Life t release, t the appinted agent f recrd n this GSI ffer, infrmatin limited t relevant details f my in frce cverage fr the purpse f determining the apprpriate level f cverage available thrugh this ffer. 12) I have read the sectin entitled Cllectin and Use f Persnal Infrmatin and understand and agree t its terms. SIGNATURE: Prpsed Insured: Date: SEE OVER

7 Pre-authrized Chequing (PAC) Agreement The Payr(s) named belw agrees that: 1. A RBC Life Insurance Cmpany ( RBC Life ) is authrized t make scheduled withdrawals t pay the premium fr this plicy, r plicies, against the accunt at the financial institutin named belw, r at any ther financial institutin that the Payr may later designate in accrdance with the rules f the Canadian Payment Assciatin ( CPA ); B C D E F G H such withdrawals will be n dates and in amunts in accrdance with the premium schedule set ut in this plicy r plicies; if the amunt f withdrawal shuld vary, pre-ntificatin by RBC Life is waived; the financial institutin indicated belw is authrized nw r at any subsequent time t hnur any requests made by RBC Life t withdraw frm the accunt indicated belw, including a representment, r redraw within 30 days shuld any withdrawal nt clear the accunt; unless therwise indicated in the Special Requests sectin belw, such withdrawals shall be dated n the day f the mnth n which the premium is due under the plicy; r, if mre than ne plicy is included in this Agreement, the withdrawals shall be dated t cincide with the existing plicy r plicies; ntificatin f any change t the accunt infrmatin prvided belw shall be given t RBC Life by the Payr five days prir t the next scheduled withdrawal. I/We agree that frm time t time, I/we may authrize RBC Life t deduct such payments frm anther accunt upn my/ur ral r written instructins; this Agreement will terminate in respect f all plicies included in it upn 10 days written ntice by RBC Life r by the Payr; a PAC may be disputed by the undersigned under the fllwing cnditins: i) if the PAC was nt drawn in accrdance with this Agreement; r ii) if this Agreement was revked. In the event that either (i) r (ii) applies, the Payr agrees t cntact RBC Life. If a satisfactry reslutin cannt be achieved between the Payr and RBC Life, then in accrdance with CPA rules, in rder t be reimbursed, the undersigned acknwledge(s) that a declaratin t the effect that either (i) r (ii) tk place must be cmpleted and presented t the branch hlding the accunt up t and including 90 calendar days in the case f a persnal PAC (r up t and including 10 business days in the case f a business PAC) after the date n which the PAC in dispute was psted t the accunt belw. I I/We acknwledge that a claim n the basis that this agreement was revked, r any ther reasn, is a matter t be reslved slely between me/us and RBC Life when disputing any PAC after the 90 calendar days in the case f a persnal PAC (r up t an including 10 business days in the case f a business PAC); the names and signatures f all persns required t authrize withdrawals frm the accunt indicated are included belw. 2. Add t existing PAC with plicy number(s) 3. Special Requests (withdrawals are limited between the 1st and 28th f the mnth) Bank infrmatin: Please attach a specimen cheque marked vid (a line f credit accunt cannt be used). Name f Bank r Financial Institutin Transit Number Bank Number Accunt Number Address City Prvince Pstal Cde Dated at this day f City Prvince Day M Yr Print Name f Payr (accunt hlder) Print Name f Secnd Payr (accunt hlder) (if any) Signature f Payr X Signature f Secnd Payr (if any) X

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