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Tax Free Savings Account (TFSA) Application

Holder Information
Designation of Beneficiary
(Note: Contract number will be added by trustee when the new application is processed.)
  1. I hereby revoke any prior Designation of Beneficiary made by me under this contract.
  2. The beneficiary(s) designated herein must survive me and accept this designation in order to receive benefits payable under this contract. If more than one beneficiary is entitled to receive benefits, they shall share the proceeds equally unless otherwise specified below. The Alternate Beneficiary designation is valid only in the event that all the Primary Beneficiaries listed herein have predeceased me or refused the designation. If no beneficiary designated herein survives me or accepts this designation, the proceeds of this contract shall be paid to my estate.
  3. All sums falling due under this contract, on or after my death, be paid to the Beneficiary(s) listed below.
  4. I understand this designation will not be recognized where I reside in Quebec at the time of my death.


Primary Beneficiary 1


Alternate Beneficiary 1
  1. Your designation of beneficiary by means of a designation form will not be revoked or changed automatically by any future marriage or divorce. Should you wish to change your beneficiary in the event of a future marriage or divorce, you will have to do so by means of a new designation.
  2. If funds contained in this contract are subject to pension legislation, the addendum governing such funds may override this designation If a person other than your spouse (or other individual who has been given similar rights under the applicable pension jurisdiction) is designated to receive the proceeds.
  3. Your estate may be responsible for reporting and paying income tax on proceeds paid to a designated beneficiary.
  4. Designations are created and governed under provincial legislation, The provincial legislation may override this designation.
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To: Concentra Trust – Trustee

  • I hereby apply for participation in the above mentioned Tax-Free Savings Account (TFSA) in accordance with the Declaration of Trust supplied to me.

  • I request the Trustee to file an election to register my qualifying arrangement as a TFSA under the Income Tax Act>(Canada).

  • I request that this contribution, and any subsequent contributions, be deposited in the Credit Union named above by the Trustee and I acknowledge that the terms and conditions of such deposits have been and will be agreed upon between myself and the Credit Union and such deposits will be held by the Trustee.

  • I hereby acknowledge that I am solely responsible for determining the amount of contribution to the TFSA.

  • I hereby agree to notify the Trustee in the event that I am no longer a resident of Canada.

  • I hereby acknowledge that I am at least 18 years of age.

  • I confirm that the information provided to Concentra Financial Services Association, its agents or affiliates (collectively "Concentra Financial") is complete and accurate. I hereby agree and consent to, and accept this as notice of, the terms of the Concentra Financial Confidentiality and Privacy Statement (located at ). I further agree and consent to Concentra Financial obtaining and retaining my personal information in order to ascertain my identity as required by the Proceeds of Crime (Money Laundering) and Terrorist Financing Act and as required by law.

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