RDSP DISABILITY ASSISTANCE PAYMENT
AND PRE-AUTHORIZED CHEQUING FORM
SECTION A – PLAN INFORMATION
SECTION B – TYPE OF DISABILITY ASSISTANCE PAYMENT (DAP/LDAP)
SECTION D – FUND SELECTION
Client Relations Phone: 1-800-387-0614
Please fax to: 1-866-766-6623
RDSP Account Number (the Plan)
Account Holder Name Beneficiary Name
Joint Account Holder (if applicable)
Disability Assistance Payment (DAP) DAP request completed by beneficiary
Lifetime Disability Assistance Payment (LDAP)
Specified Year Disability Assistance Payment (Please include Doctor’s signed certification that beneficiary’s life expectancy is 5 years or less)
Net Gross
$
For Lifetime Disability Assistance Payments (LDAP): indicate frequency
Monthly Bi-Monthly Quarterly Semi-Annually
Annually; with the first payment to commence ____________________________________________________
I understand that, for Disability Assistance payments (DAP/LDAP):
a. Repayment to ESDC is required of all Grant and Bond received into this Plan within the previous ten years (minus any Grant or Bond already repaid).
b. Plan value after DAP/LDAP must be greater than total of all Grant and Bond received by the Plan within the previous ten years (minus any Grant or Bond already repaid).
c. Where government contributions to the Plan exceed private contributions, maximum payment amounts will be determined as stipulated by the Income Tax Act, Canada
d. If LDAP has been selected, above, once initiated, payments must be made at least annually
e. T4A will be issued to the beneficiary for the taxable amount of the payment
f. The money received from this/these payment(s) is to be used for the exclusive benefit of the beneficiary of this Plan
For Disability Assistance Payments (DAP/LDAP):
Mail cheque to: __________________________________________________________________________________ EFT (Please provide imprinted VOID cheque)
SECTION C – PAC/PAD AUTHORIZATION
– Please read carefully before signing
Indicate the fund(s) from/to which the payment(s) or contribution(s) is/are to be made
FUND NUMBER FUND NAME DOLLAR AMOUNT ($) FUND NUMBER FUND NAME DOLLAR AMOUNT ($)
I/We hereby authorize and request Mackenzie Investments to draw on my/our account at the Bank named above, whether the account continues to be maintained at the branch or is transferred to another branch at the Bank. I/We
acknowledge that I/We have read and agree to be bound by the Pre-Authorized Chequing (Pre-Authorized Debit) Terms and Conditions attached to this application. By signing this form the contributor consents to sharing banking
information with the RDSP account holder for the express purpose of making a one-time or ongoing contributions to the above-noted RDSP.
Where bank account holder(s) is/are not the RDSP Holder, please also complete and submit the RDSP Holder Consent to Non-Holder Contributions form.
TO: AND TO: Mackenzie Investments (PROVIDE PROOF OF BANKING)
Use banking info on file
A
One-time Purchase on for $
Select One: Add Change Stop
B Frequency for recurring PACS
Undersigned’s Bank
Weekly
Bi-Weekly
1
Monthly Quarterly Annually
Semi-Monthly
2
Bi-Monthly
3
Semi-Annually
4
1
Once every 14 days
2
Only on/around 15
th
and end of month
3
Every other month
4
Every six months
Date (DD MMM YYYY)
Protect PAC against inflation by an annual
increment of % or $
starting from Date (DD MMM YYYY)
Date (DD MMM YYYY)
Date (DD MMM YYYY)
Bank Account Holder’s Name
Joint Bank Account Holder’s Name
Bank Account Holder’s Signature
Joint Bank Account Holder’s Signature
X
X
My first purchase
is to commence
Date (DD MMM YYYY)
Total amount per run date: $
SECTION E – ACCOUNT HOLDER AUTHORIZATION
Dealer Name Dealer Code Advisor Name Advisor Code
Join
t Account Holder Signature (if applicable)
Beneficiary Signature (if applicable)
Advisor Signature
Account Holder Signature
Date
DD MMM YYYY
Date
DD MMM YYYY
Date
DD MMM YYYY
Date
DD MMM YYYY
AFFIX SIGNATURE GUARANTEE STAMP
Mackenzie Investments, 180 Queen Street West, Toronto, Ontario M5V 3K1
DEFINITIONS
“Account Holder” means:
(i) an entity that has entered into the Plan with the Trustee;
(ii) an entity who receives rights as a successor or assignee of an entity who entered into the Plan
with the Trustee; and
(iii) the Beneficiary, if the Beneficiary has rights under the Plan to make decisions concerning the
Plan, unless the Beneficiary’s only right is to request that Disability Savings Payments be made
as detailed in section 12(b).
“Assistance Holdback Amount” has the meaning assigned under the Canada Disability Savings
Regulations.
“Beneficiary” means the individual designated in the application by the Account Holder(s) to whom,
or on whose behalf, Lifetime Disability Assistance Payments and Disability Assistance Payments shall
be paid.
“Disability Assistance Payment” means any payment from the Plan to the Beneficiary or to the
Beneficiary’s estate.
“Lifetime Disability Assistance Payments” means Disability Assistance Payments that, after they begin
to be paid, are payable at least annually until the earlier of the day on which the Beneficiary dies and
the day on which the Plan is terminated.
“Registered Disability Savings Plan” means a Disability Savings Plan that satisfies the conditions of
section 146.4 of the ITA.
“Specified Year” as found in the RDSP Declaration of Trust must be read to include years in which the
Plan is an SDSP.
PAC/PAD TERMS AND CONDITIONS
a)
By signing this agreement, you hereby waive any confirmation and pre-notification requirements
as specified by section 17 of the Canadian Payments Association Rule H1 with regards to
pre-authorized debit (PADs).
b) You authorize Mackenzie Financial Corporation (Mackenzie) to debit the bank account(s) provided
for the amount(s) and in the frequencies instructed.
c) If this is for your own personal investment, your debit will be considered a Personal PAD by the
Canadian Payments Association (CPA) definition. If this is for business purposes, it will be considered
a Business PAD. Monies transferred between CPA members will be considered a Funds Transfer PAD.
d) If this is for a one-time PAD agreement, only a single one-time PAD is permitted. Your authority
is to remain in effect until the one-time PAD is completed, at which time this PAD agreement for
the one-time request will automatically terminate.
e) You acknowledge that for a one-time PAD, the Payor’s PAD is no longer valid once the payment has
been fulfilled. Any subsequent PAD request requires a newly authorized Payor’s PAD agreement.
f) You have certain recourse rights if any debit does not comply with this PAD agreement. For
example, you have the right to receive reimbursement for any debit that is not authorized or is
not consistent with this PAD agreement. To obtain more information on your recourse rights, you
may contact your financial institution or visit www.payments.ca.
g) You confirm that all persons whose signatures are required to authorize transactions in the bank
account(s) provided have signed this agreement.
h) You may change these instructions or cancel this plan at any time, provided that Mackenzie receives
at least 10 (ten) business days’ notice by phone or by mail. You can also obtain further information
regarding the Mackenzie’s practices related to personal information, privacy, and information
security. Contact information for Mackenzie can be found within the form. To obtain a copy of a
cancellation form or for more information regarding your right to cancel a pre-authorized debit
agreement, please consult with your financial institution or visit the Canadian Payments Association
website at www.payments.ca. You agree to release the financial institution of all liability if the
revocation is not respected, except in the case of gross negligence by the financial institution.
i) Mackenzie may cease issuing your PAD agreement in accordance with Rule H1.
j) Mackenzie is authorized to accept changes to this agreement from your registered dealer or your
financial advisor in accordance with the policies of that company, in accordance with the disclosure
and authorization requirements of the CPA.
k) You agree that the information in this form will be shared with the financial institution, insofar as
the disclosure of this information is directly related to and necessary for the proper application
of the rules applicable for pre-authorized debits.
l) You acknowledge and agree that you are fully liable for any charges incurred if the debits cannot
be made due to insufficient funds or any other reason for which you may be held accountable.
m)
For Quebec clients only/Pour les clients et clientes du Québec seulement: You acknowledge
to have received the French version of this PAD agreement and that you have chosen to complete
the English version of this document and requested that all related current and future documents
be provided in English. Vous reconnaissez avoir reçu la version française de la présente entente
de DPA, avoir choisi de remplir la version anglaise du document et avoir demandé à ce que tous
les documents connexes actuels et futurs vous soient fournis en anglais.
Revised: December 2023
RDSP DISABILITY ASSISTANCE PAYMENT
AND PRE-AUTHORIZED CHEQUING FORM
SECTION A – PLAN INFORMATION
SECTION B – TYPE OF DISABILITY ASSISTANCE PAYMENT (DAP/LDAP)
SECTION D – FUND SELECTION
Client Relations Phone: 1-800-387-0614
Please fax to: 1-866-766-6623
RDSP Account Number (the Plan)
Account Holder Name Beneficiary Name
Joint Account Holder (if applicable)
Disability Assistance Payment (DAP) DAP request completed by beneficiary
Lifetime Disability Assistance Payment (LDAP)
Specified Year Disability Assistance Payment (Please include Doctor’s signed certification that beneficiary’s life expectancy is 5 years or less)
Net Gross
$
For Lifetime Disability Assistance Payments (LDAP): indicate frequency
Monthly Bi-Monthly Quarterly Semi-Annually
Annually; with the first payment to commence ____________________________________________________
I understand that, for Disability Assistance payments (DAP/LDAP):
a. Repayment to ESDC is required of all Grant and Bond received into this Plan within the previous ten years (minus any Grant or Bond already repaid).
b. Plan value after DAP/LDAP must be greater than total of all Grant and Bond received by the Plan within the previous ten years (minus any Grant or Bond already repaid).
c. Where government contributions to the Plan exceed private contributions, maximum p
ayment amounts will be determined as stipulated by the Income Tax Act, Canada
d. If LDAP has been selected, above, once initiated, payments must be made at least annually
e. T4A will be issued to the beneficiary for the taxable amount of the payment
f. The money received from this/these payment(s) is to be used for the exclusive benefit of the beneficiary of this Plan
For Disability Assistance Payments (DAP/LDAP):
Mail cheque to: __________________________________________________________________________________ EFT (Please provide imprinted VOID cheque)
SECTION C – PAC/PAD AUTHORIZATION
– Please read carefully before signing
Indicate the fund(s) from/to which the payment(s) or contribution(s) is/are to be made
FUND NUMBER FUND NAME DOLLAR AMOUNT ($) FUND NUMBER FUND NAME DOLLAR AMOUNT ($)
AP1038 3455032 12/23
