Corporate/Non-Corporate

Entity/Trust Ownership Form

IP-LP1166 7/14

CORPORATE/NON-CORPORATE
ENTITY/TRUST OWNERSHIP FORM

5005000 Yonge Street

Toronto, ON M2N 7J8

Applicant Name_________________________________________________________________________ Policy No. (if available)___________________________________________________________________

corporation/non-corporate ENTITY/TRUST IDENTIFICATION This form along with the International Tax Classification for an Entity Form (IP-LP1601) must
be completed if the Owner(s) is a Corporation, Non-Corporate Entity or a Trust.
1. Please provide the following information on the individual(s) submitting an application on behalf of a Corporation, Non-Corporate Entity or Trust.
Identification
Name of Individual Job Title Document*

Identification
Document Number* Issuing Jurisdiction*

_______________________________ ______________________ _____________________

____________________ ______________________

_______________________________ ______________________ _____________________

____________________ ______________________

_______________________________ ______________________ _____________________

____________________ ______________________

*Please refer to an original non-expired passport, birth certificate, drivers license, Canadian Citizenship, Age of Majority or Canadian Armed Forces Identification (preferably photo ID).

2. Corporation Please provide Corporate information including corporate structure document. For more information on supporting documents required refer to the
Summary Table.
_______________________________________________________________________________________________________________________________
Official Corporate Name
_______________________________________________________________________________________________________________________________
Address
_______________________________________________________________________________________________________________________________
Place of Federal or Provincial Incorporation
Corporation Registration Number
Names of all Directors of Corporation (If necessary, attach listing of all directors)

Occupation

_______________________________________________________________________________________________________________ __________________________________________________________________
_______________________________________________________________________________________________________________ __________________________________________________________________
_______________________________________________________________________________________________________________ __________________________________________________________________
_______________________________________________________________________________________________________________ __________________________________________________________________
_______________________________________________________________________________________________________________ __________________________________________________________________
Names of all individuals
Occupation
Address
who directly or indirectly own or control 25%
or more of the shares of the Corporation.
_______________________________________________________________________________ _____________________________ __________________________________________________________________
_______________________________________________________________________________ _____________________________ __________________________________________________________________
_______________________________________________________________________________ _____________________________ __________________________________________________________________
_______________________________________________________________________________ _____________________________ __________________________________________________________________
Note: Please submit this form with your application.

*FRM-IPLP1166*
IP-LP1166 7/14

3. Non-Corporate Entity Please provide Non-Corporate Entity Information. For more information on supporting documents required refer to the Summary Table.
_______________________________________________________________________________________________________________________________
Official Name of Entity
_______________________________________________________________________________________________________________________________
Address
_______________________________________________________________________________________________________________________________
Place of Issue
Registration Number
_______________________________________________________________________________________________________________________________
Type of Entity/Document
Name of all individuals who directly or indirectly own or control 25% or
more of the Non-Corporate Entity.

Occupation

Address

________________________________________________________________________________________________________ _________________________________ _________________________________________________________________

________________________________________________________________________________________________________ _________________________________ _________________________________________________________________
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________
________________________________________________________________________________________________________ _________________________________ _________________________________________________________________
4. Trust Please provide Trust Information. For more information on supporting documents required refer to the Summary Table.
Name of person who created the Trust (Settlor)
Address
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
Name of Trustee
Address
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
Name of Beneficiary
Address
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
________________________________________________________________________________________________________ _____________________________________________________________________________________________________
Certification by Authorized Signing Officer/person with signing authority of Entity
I certify the above is a full, complete and accurate disclosure in respect of the Entity. I also have the authority to sign this Form on behalf of the Entity.
Print Name & Title _________________________________________________________________
Signature________________________________________________________________________ Date (DD/MM/YYYY) ______________________________
Advisors Notes and Comments
________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________
Advisor Verification/Information
I have verified the identity of the individual who submitted the application by referring to the original documents referred to above and that the information recorded was
correctly copied from such document.

Name of Advisor
Signature of Advisor

Dealer/GA Code

Date (DD/MM/YYYY)

Rep/Advisor Code

Summary Table
Type of account

Corporation
(Complete section 1, 2 and sign Certification section)

Non-Corporate Entity
(Complete section 1, 3 and sign Certification section)

What information must be submitted

Name and address of the corporation
Names of all directors of the corporation
Names and addresses of all individuals who directly or indirectly own or control 25% or more of the
shares of the corporation.
(If this information cannot be obtained, we must keep a record explaining why beneficial ownership could
not be determined).
Certificate of Incumbency
International Tax Classification for an Entity Form (IP-LP1601)
Name and address of the entity
Name and address of all individuals who directly or indirectly own or control 25% or more of the entity.
(If this information cannot be obtained, we need to keep a record explaining why beneficial ownership
could not be determined).
Certificate of Incumbency
International Tax Classification for an Entity Form (IP-LP1601)
And include one of the following:
Partnership Agreement
Articles of association
Other similar record that confirms the entitys existence

Trust
(Complete section 1, 4 and sign Certification section)

Name and address of all trustees

Name and address of all known beneficiaries
Name and address of all known settlors of the trust
Certificate of Incumbency
International Tax Classification for an Entity Form (IP-LP1601)

And include one of the following:

Trust Agreement
Trust Deed
Declaration of Trust
Other similar record that confirms the entitys existence

5005000 Yonge Street

Toronto, Ontario M2N 7J8
www.transamerica.ca

Aegon and the Aegon logo are registered trademarks of Aegon N.V. Aegon Canada ULC and its affiliated companies are licensed to use such marks.

Transamerica and the pyramid design are registered trademarks of Transamerica Corporation. Transamerica Life Canada is licensed to use such marks.

IP-LP1166 7/14