THE EMPIRE LIFE INSURANCE COMPANY LIFE INCOME FUND ENDORSEMENT QUÉBEC SUPPLEMENTAL PENSION PLANS ACT AND REGULATIONS

Transcription

1 Policy Number: THE EMPIRE LIFE INSURANCE COMPANY LIFE INCOME FUND ENDORSEMENT QUÉBEC SUPPLEMENTAL PENSION PLANS ACT AND REGULATIONS Owner/Annuitant: The Policy Number indicated above is amended as described in the following provisions. Where applicable, these Life Income Fund Provisions shall override any other provision to the contrary. Definitions Annuitant and/or Owner have the same meaning given to the term purchaser in the Act. we, us, our, and the Company means The Empire Life Insurance Company; you, and your means the Owner of the Life Income Fund policy. LIF1 General Provisions This policy is subject to the following conditions: i) For the purposes of this endorsement the word "Act" shall mean The Québec Supplemental Pension Plans Act and the word "Regulation" shall mean the Regulation Respecting Supplemental Pension Plans under the Act, and as these may be amended from time to time; ii) Where used throughout this endorsement, the following terms shall have the same meanings as those defined in the Act and Regulation "life income fund (LIF)", "locked-in retirement account (LIRA)", "pension", and "spouse"; iii) Notwithstanding anything to the contrary contained in this contract, including any endorsements forming a part thereof, "spouse" does not include any person who is not recognized as a spouse for the purposes of any provision of the Income Tax Act (Canada) respecting Registered Retirement Income Funds; iv) where used in this endorsement the term locked-in money shall include all interest, gains and losses attributable to such deposits of locked-in money; v) this policy must comply with the conditions for registration as a Registered Retirement Income Fund under the Income Tax Act (Canada) and, once registered, must remain registered; vi) that the funds in the policy shall be invested in a manner that complies with the rules for the investment of funds in a Registered Retirement Income Fund, as defined in section of the Income Tax Act (Canada) and the Regulations thereunder; vii) that this policy may not be assigned, charged, anticipated or given as security in whole or in part and is exempt from execution, seizure or attachment. Further, any transaction which purports to assign, charge, anticipate or give as security the balance of the funds in this policy at any time is void; viii) that should any of the value of this policy be paid out in a manner contrary to these provisions or the Regulation, we will determine the value of the policy as if such payment had not been made unless such payment was the result of a false statement by you; ix) that we may not make any amendments to the contract unless; a) we are required by law to make the amendment, b) the amendment remains in conformity with the standard contract amended and registered with the applicable provincial and federal legislative authority and with the Régie des rentes du Québec, c) you have been given at least 90 days prior notice of the proposed amendment (other than an amendment described in item a) above), and d) if the amendment reduces benefits under the contract, you may transfer the balance and receive, not less than 90 days before the date on which you may exercise that right, a notice indicating the nature of the amendment and the date from which you may exercise that right. LIF2 Additional Deposits Additional deposits may be made, by you, into this policy at any date following the Policy Date providing this policy remains in force. In any event, no deposit will be accepted under this policy unless the deposits are transfers coming directly or indirectly from a pension plan subject to the Act or referred to in subsection 1, 2, 4 or 5 of section 28 of the Regulation or another life income fund. All deposits transferred to this policy will be deemed to be transfers from another life income fund under which you are the Owner unless you provide a completed declaration in conformity with the declaration prescribed in schedule 0.9 of the Regulation. November 2011 Page 1 of 4

2 LIF3 Temporary Income Payments A) Over age 54 and under age 65 at the end of the year preceding the year of application You may elect to apply for payment of a temporary income, the amount of which is determined by you subject to the limits outlined in sections 20.3 and 20.4 of the Regulation, at any time during the fiscal year of the fund subject to the following conditions: i) your application for a temporary income must be accompanied by a completed declaration to this effect in conformity with the declaration prescribed in Schedule 0.4 of the Regulation; and ii) you must have attained at least the age of 54 years but be under the age of 65 years at the end of the year preceding the date of application. If the payment of any portion of the temporary income is to be made in the form of a transfer to another retirement savings instrument of which the balance is not to be converted to a life annuity, such portion of the payment may not exceed the Maximum Amount determined in accordance with section 20 of the Regulation, determined by assuming that you are not entitled to payment of a temporary income. In the event you elect to determine an increased maximum temporary income in accordance with section 20.4 of the Regulation during any fiscal year, you must provide us with completed declarations in conformity with the declarations prescribed in schedules 0.4 and 0.8 of the Regulation. The temporary income payable in accordance with this provision may not be paid after the end of the year in which you attain age 65. B) Less than age 54 at the end of the year preceding the year of application You may elect to receive annually the balance of the value of the fund, in whole or in part, in the form of a temporary income payable in equal monthly payments, none of which may exceed the limits outlined in section 19.2 of the Regulation, subject to the following conditions: i) your application for such temporary income must be accompanied by a completed declaration to this effect in conformity with the declaration prescribed in Schedule 0.5 of the Regulation and your written undertaking to request a suspension of such payments as soon as your income, excluding this temporary income, reaches the limits prescribed in subsection 1 of section 19.2 of the Regulation; and ii) you must have been less than 54 years of age at the end of the year preceding the date of application. This temporary income will not be paid where you have requested a suspension of payments nor after the end of the year in which you attain 54 years of age. If you are a member, or the spouse of a member, who has become entitled to a pension under a pension plan, you may, for the purpose of replacing such pension by a temporary income, apply once a year for the transfer from that pension plan to this policy, an amount equal to the lesser of a) the additional amount required for the value of this policy to allow, until the end of such year, the payment of the temporary income outlined in section 19.2 of the Regulation, and b) the value of your benefits under the plan. LIF4 Retirement Income Payments You shall be paid income payments, the amount of which may vary annually, until the day on which the balance of the locked-in money in the policy is used to purchase a life annuity contract as stipulated in subparagraph 60(l) of the Income Tax Act (Canada). The retirement income payments to be made with respect to this policy shall be made in accordance with the directions provided in the application. The fiscal year of the fund must end on December 31st of each year and may not exceed 12 months. Unless otherwise directed, payment in any fiscal year will be made in equal monthly instalments and for an amount that is one-twelfth the amount that is deemed to be the Minimum Amount required to be paid out during the fiscal year as described in section 20.2 of the Regulation and Section 146.3(1) of the Income Tax Act (Canada) and as may be amended from time to time. Other payment methods may be elected subject to the approval of the Company. In any event, any payment method which is chosen must meet the provisions of both the Income Tax Act (Canada) and of this policy. The Maximum Amount to be paid out under the Life Income Fund for each fiscal year shall be determined in accordance with section 20.1 of the Regulation. In addition to the regular income payments being made in accordance with the Life Income Fund, unscheduled lump sum income payments may be requested during any fiscal year, in accordance with the policy provisions, with the restriction that the sum of the scheduled income payments and the unscheduled payments in a particular year does not exceed the Maximum Amount for that year. November 2011 Page 2 of 4

3 LIF5 Death Benefit The Death Benefit applies up to the point in time at which the totality of the Life Income Fund balance has been converted into a life annuity. Once the balance has been converted into a life annuity the terms of the annuity shall apply. If you die while this policy is in force the Death Benefit Value, to the extent permitted by the Income Tax Act (Canada), your spouse or, if there is none, your named beneficiary shall receive the Death Benefit Value of the policy. If there is no spouse or named beneficiary, the Death Benefit Value shall be paid to your Estate. Your spouse is automatically the Beneficiary until he or she ceases to be entitled to this benefit for one of the reasons listed in provision LIF6. Spousal status shall be determined as of the day preceding the date of your death. The Death Benefit for the Life Income Fund shall be the sum of the Death Benefit amounts payable under each investment option as determined in accordance with the policy provisions for that option. LIF6 Annuity Benefit You may, at any time while this policy is in force, elect to convert the total balance of the life income fund into an immediate life annuity, as specified in subparagraph 60(l) of the Income Tax Act (Canada). In this case the amount used to purchase the life annuity shall be equal to the sum of the Surrender Values payable under each investment option as determined in accordance with the provisions for that option. This policy can be converted to a life annuity only upon the following conditions: i) the insurer guarantees payment of that annuity at least annually in periodic equal amounts that may not vary unless each amount to be paid is: a) uniformly adjusted in accordance with an index or a rate provided for in the annuity contract, in accordance with section 60(l) of the Income Tax Act (Canada), or b) uniformly adjusted by reason of a seizure effected on your benefits, or c) a redetermination of your pension, or d) by reason of a partial commutation of the annuity benefit to provide for the partition of your benefits with your spouse in settlement of rights arising out of, or on the breakdown of, your marriage, or e) the payment of a temporary pension under the conditions provided for in section 91.1 of the Act, or f) by reason of the election provided for under subsection (3) of section 93 of the Act; ii) the insurer must guarantee, to a Spouse who has not waived it, a surviving Spouse's pension which is a life annuity of at least 60% and at most 100% of the annuity payable immediately before the death of the annuitant including, during the replacement period, the amount of any temporary pension; iii) the insurer may guarantee payment during a given period extending after death but not later than the date preceding the annuitant's 90th birthday; and iv) you must supply proof of age for both yourself and your Spouse if appropriate. Your spouse may, at any time prior to conversion of the totality of the account balance into a life annuity, waive entitlement to a surviving spouse's pension or revoke such a waiver by completing the required documents. The spouse ceases to be entitled to the benefits provided for under this section, provision LIF5, LIF7 or, as the case may be, under provision LIF8, upon receipt of proof acceptable to the Company of separation from bed and board, divorce, nullity of marriage, nullity or dissolution of a civil union or, in the case of a spouse who is not a married or civil union spouse, upon cessation of the conjugal relationship, except in the cases and conditions as provided for in section 89 of the Act. LIF7 Withdrawal Benefit You may apply to withdraw the policy value as a lump sum subject to the following conditions: i) a) you must have attained at least the age of 65 at the end of the year preceding the date application to withdraw the policy value is made; and b) the aggregate of the sum accumulated to your account in the following plans defined contribution pension plans, defined contribution-defined benefit pension plans, by applying provisions identical to those for a defined contribution pension plan, life income funds locked-in retirement accounts, and locked-in RRSP s November 2011 Page 3 of 4

4 does not exceed 40% of the Maximum Pensionable Earnings determined in accordance with the Act respecting The Québec Pension Plan for the year during which you apply for such withdrawal. Your application for a withdrawal must be accompanied by a completed declaration to this effect in conformity with the declaration prescribed in Schedule 0.2 of the Regulation; or ii) the seizable portion of the balance of the policy value may be paid in a lump sum in execution of a judgment rendered in favour of your spouse that gives entitlement to a seizure for unpaid alimony, or iii) if you have not resided in Canada for at least two years. We reserve the right to require proof on non-residency, at your expense and in a form satisfactory to us, prior to the payment of the value. The value for withdrawal shall be the sum of the values calculated in accordance with the provisions for each investment option less any fees or charges which may apply in accordance with the policy provisions. LIF8 Transfers At any time, the Life Income Fund provides that at your written direction, we shall transfer all or part of the Life Income Fund Value as well as any additional information necessary for the continuance of the Fund, to another institution who has agreed to provide: i) another Life Income Fund registered as a RRIF for you; or ii) iii) an immediate life annuity as stipulated in paragraph 60(l) of the Income Tax Act (Canada), that has been issued by an insurer with a guarantee that the annuity shall meet the requirements of section 23 of the Regulations; or to another pension plan governed by the Act or referred to in paragraph 1 or 2 of section 28 of the Regulations; or iv) to a Locked-in Retirement Account contract, which meets the requirements of section 29 of the Regulation and under which you are the Annuitant, if the transfer takes place before the latest date prescribed for the maturity of a registered retirement savings plan under the Income Tax Act (Canada). Any such transfer shall be subject to the requirements of the Act and Regulation and the Income Tax Act (Canada). Such value shall be the sum of the values calculated in accordance with the provisions for each investment option less any fees or charges which may apply in accordance with the policy provisions. Any such transfers shall be made within 30 days of the completion and filing of all documents required to authorize the transfer, including any required evidence. LIF9 Life Income Fund Statements We will, at the beginning of each calendar year while this policy is in force, provide to you a statement providing the information required under section 24 of the Regulation. In the event of your death, we will provide to the surviving spouse, designated beneficiary or the administrator or executor of your estate a statement with the information in paragraph 1 of section 24 of the Regulation, established at the date of your death. In the event of a total transfer out of the Company or a conversion of the Life Income Fund, we will provide to you a statement with the information in paragraph 1 of section 24 of the Regulation, established at the date of transfer or conversion, as appropriate. If: a) deposits are made to this policy which do not originate directly or indirectly from a life income fund as described in LIF2, Additional Deposits; or b) if you advise us of the maximum temporary income that you have determined for that fiscal year as described in LIF3, Temporary Income Payments, Over age 54 and under age 65 at the end of the year preceding the year of application we will, within 30 days, provide to you a statement providing the information required under section 24.1 of the Regulation. Date Issued at the Head Office of the Company Mr. Leslie C. Herr President and Chief Executive Officer November 2011 Page 4 of 4

5 THE EMPIRE LIFE INSURANCE COMPANY LOCKED-IN RETIREMENT ACCOUNT ENDORSEMENT QUÉBEC SUPPLEMENTAL PENSION PLANS ACT AND REGULATIONS Policy Number: Owner/Annuitant: The Policy Number indicated above is amended as described in the following provisions. Where applicable, these Locked-In Retirement Account Provisions shall override any other provision to the contrary. Definitions Annuitant and/or Owner have the same meaning given to the term purchaser in the Act. If this Locked-In Retirement Account endorsement is attached to a group retirement savings plan, Owner as used in this endorsement refers to the participating member under the plan. we, us, our, and the Company means The Empire Life Insurance Company; you, and your means the Owner of the Locked-In Retirement Account policy. LIRA1 General Provisions This policy is subject to the following conditions: i) In this endorsement the word "Act" means The Québec Supplemental Pension Plans Act and the word "Regulation" means the Regulation Respecting Supplemental Pension Plans under the Act, and as these may be amended from time to time; ii) In this endorsement, the following terms shall have the same meanings as those defined in the Act and Regulations: "life income fund (LIF)", "locked-in retirement account (LIRA)", "pension", and "spouse"; iii) Notwithstanding anything to the contrary contained in this contract, including any endorsements forming a part thereof, "spouse" does not include any person who is not recognised as a spouse for the purposes of any provision of the Income Tax Act (Canada) respecting Registered Retirement Savings Plans; iv) Where used in this endorsement the term locked-in money shall include all interest, gains and losses attributable to such deposits of locked-in money; v) This policy must comply with the conditions for registration as a Registered Retirement Savings Plan under the Income Tax Act (Canada) and, once registered, must remain registered; vi) The funds in the policy shall be invested in a manner that complies with the rules for the investment of funds in a Registered Retirement Savings Plan, as defined in section of the Income Tax Act (Canada) and the Regulations thereunder; vii) This policy may not be assigned, charged, anticipated or given as security in whole or in part and is exempt from execution, seizure or attachment. Further, any transaction which purports to assign, charge, anticipate or give as security the balance of the funds in this policy at any time is void; viii) Subject to item vii) above and provision LIRA6 and LIRA7 of this endorsement, no withdrawal, commutation or surrender of locked-in money is permitted during the lifetime of the Owner except where an amount is required to be paid to the Owner to reduce the amount of tax otherwise payable under Part X.1 of the Income Tax Act (Canada); ix) that should any of the value of this policy be paid out in a manner contrary to these provisions or the Regulation, we will determine the value of the policy as if such payment had not been made unless such payment was the result of a false statement by you; x) that we may not make any amendments to the contract unless: a) we are required by law to make the amendment; b) the amendment remains in conformity with the standard contract amended and registered with the applicable provincial and federal legislative authority and with the Régie des rentes du Québec; c) you have been given at least 90 days prior notice of the proposed amendment (other than an amendment described in item a) above); and d) if the amendment reduces benefits under the contract, you may transfer the balance and receive, not less than 90 days before the date on which you may exercise that right, a notice indicating the nature of the amendment and the date from which you may exercise that right. November 2011 Page 1 of 4

6 LIRA2 Additional Deposits Additional deposits may be made, by you, into this policy at any date prior to the Maturity Date of the Policy. In any event, no deposit will be accepted under this policy unless the deposits are transfers of locked-in money from: i) a Locked-in Registered Retirement Savings Plan under which you are the annuitant; or ii) a Life Income Fund registered as a Registered Retirement Income Fund (RRIF) under which you are the Annuitant; or iii) a Registered Pension Plan under which you are a member, governed by the Act or referred to in paragraph 1, 2 or 5 of Section 28 of the Regulation; or iv) another Locked-in Retirement Account contract under which you are the Annuitant. LIRA3 Pension Benefit The total balance of the value of the policy must be converted to a life annuity no later than the latest date for maturity of a registered retirement savings plan as prescribed under the Income Tax Act (Canada). With the exception of the cases referred to in subparagraphs 3 and 8 to 9.1 of Section 29 of the Regulation, the balance of the value of the policy may only be converted into a life annuity guaranteed by an insurer and established for the duration of your lifetime alone or for the duration of your lifetime and the life of your spouse. If you have not provided the Company with the required documentation to commence payment of pension benefits, we will, before the latest date for maturity of a registered retirement savings plan as prescribed under the Income Tax Act (Canada), purchase an immediate life annuity contract for you based on our then current annuity rates and as stipulated in section 146(1) of the Income Tax Act (Canada) or provide for a pension in compliance with the Act and Regulations. The amount used for this purchase shall be equal to the sum of the Maturity Values payable under each investment option as determined in accordance with the provisions for that option. At any time prior to the Maturity Date, if the policy has not been otherwise settled under provision LIRA4, LIRA5, LIRA6 or LIRA7, you may request conversion to a life annuity. In this case the amount used to purchase the life annuity shall be equal to the sum of the Surrender Values payable under each investment option as determined in accordance with the provisions for that option. This policy can be converted to a life annuity only upon the following conditions: i) the insurer guarantees payment of that annuity at least annually in periodic equal amounts that may not vary unless each amount to be paid is: a) uniformly adjusted in accordance with an index or a rate provided for in the annuity contract, in accordance with section 146(1) of the Income Tax Act (Canada), or b) uniformly adjusted by reason of a seizure effected on your benefits, or c) a redetermination of your pension, or d) by reason of a partial commutation of the annuity benefit to provide for the partition of your benefits with your spouse in settlement of rights arising out of, or on the breakdown of, your marriage; or e) the payment of a temporary pension under the conditions provided for in section 91.1 of the Act, or f) by reason of the election provided for under paragraph 3 of the first paragraph of section 93 of the Act; ii) the insurer must guarantee, to a Spouse who has not waived it, a surviving Spouse's pension which is a life annuity of at least 60% and at most 100% of the annuity payable immediately before the death of the Annuitant including, during the replacement period, the amount of any temporary pension; iii) the insurer may guarantee payment during a given period extending after death but not later than the date preceding the Annuitant's 90th birthday; and iv) you must supply proof of age for both yourself and your Spouse if appropriate. Your spouse may, at any time prior to conversion of the totality of the account balance into a life annuity, waive entitlement to a surviving spouse's pension or revoke such a waiver by completing the required documents. The spouse ceases to be entitled to the benefits provided for under this section, provision LIRA4, LIRA5 or, as the case may be, under provision LIRA7, upon receipt of proof acceptable to the Company of separation from bed and board, divorce, nullity of marriage, dissolution or nullity of civil union, or, in the case of spouse who is not a married or civil union spouse, upon cessation of the conjugal relationship, except in the cases and conditions provided for in section 89 of the Act. LIRA4 Death Benefit If you die before the date on which this policy has been settled under Provision LIRA3, LIRA5, LIRA6 or LIRA7, your spouse or, if there is none, your named beneficiary shall receive the Death Benefit Value of the policy. If there is no spouse or named beneficiary, November 2011 Page 2 of 4

7 the Death Benefit value shall be paid to your Estate. Your spouse is automatically the Beneficiary until he or she ceases to be entitled to this benefit for one of the reasons listed in provision LIRA3. Spousal status shall be determined as of the day preceding the date of your death. The Death Benefit Value for the Locked-In Retirement Account shall be the sum of the Death Benefit amounts payable under each investment option as determined in accordance with the policy provisions for that option. LIRA5 Transfers At any time, the Locked-In Retirement Account provides that at your written direction, we shall transfer all or part of the Value of the Locked-In Retirement Account to: i) another Locked-In Retirement Account; or ii) purchase an immediate or deferred life annuity contract, as described in section 30 of the Regulation and as stipulated in paragraph 146(1) of the Income Tax Act (Canada). If you have a spouse, the life annuity contract shall be a joint pension in accordance with subsection 30(4) of the Regulation and section 146(1) of the Income Tax Act (Canada) unless your spouse has waived entitlement to a joint pension as described in subsection 30(5) of the Regulation; or iii) to another pension plan governed by the Act or referred to in paragraph 1 or 2 of section 28 of the Regulation; or iv) to a Life Income Fund contract under which you are the Annuitant. Any such transfer shall be subject to the requirements of the Act and Regulation and the Income Tax Act (Canada). Such transfer of value shall be the sum of the values calculated in accordance with the provisions for each investment option less any fees or charges which may apply in accordance with the policy provisions. Any such transfers shall be made within 30 days of the completion and filing of all documents required to authorize the transfer, including any required evidence. LIRA6 Withdrawal Benefit You may apply to withdraw the policy value as a lump sum subject to the following conditions: i) a) you must have attained at least the age of 65 at the end of the year preceding the date application to withdraw the policy value is made; b) the aggregate of the sum accumulated to your account in the following plans defined contribution pension plans, defined contribution-defined benefit pension plans, by applying provisions identical to those for a defined contribution pension plan, life income funds locked-in retirement accounts, and locked-in RRSP s does not exceed 40% of the Maximum Pensionable Earnings determined in accordance with the Act Respecting The Québec Pension Plan for the year during which you apply for such withdrawal. Your application for a withdrawal must be accompanied by a completed declaration to this effect in conformity with the declaration prescribed in Schedule 0.2 of the Regulation; or ii) the seizable portion of the balance of the policy value may be paid in a lump sum in execution of a judgment rendered in favour of your spouse that gives entitlement to a seizure for unpaid alimony; or. iii) if you have not resided in Canada for at least two years. We reserve the right to require proof of non-residency, at your expense and in a form satisfactory to us, prior to the payment of the value. The value for withdrawal shall be the sum of the values calculated in accordance with the provisions for each investment option less any fees or charges which may apply in accordance with the policy provisions. LIRA7 Disability Benefit Notwithstanding any provision to the contrary, you may elect to withdraw the policy value as a lump sum or series of payments for the purposes of subsection 29(9) of the Regulation, where a physician has certified that, due to a mental or physical disability, your life expectancy is reduced. Such payment shall only be made where your spouse has waived the entitlement to the joint life pension and filed such waiver with our Head Office. November 2011 Page 3 of 4

8 Further, we reserve the right to require further information or proof of disability, at your expense, prior to the release of such funds to you. LIRA8 Annual Statements Each calendar year we will provide you with a statement indicating: i) the sums deposited; ii) their source; iii) the accumulated earnings; iv) the fees deducted since the last statement; and v) the Fund value at the end of such calendar year. Date Issued at the Head Office of the Company Mr. Leslie C. Herr President and Chief Executive Director November 2011 Page 4 of 4