Client Profile — Adautin Wealth Management Inc.

Section 1 of 7

About you

Identity, residency and employment. Every application you complete with us draws from this section, so it is asked once.

What are you completing today?

Select everything that applies. The form shows only the sections you need.

Investment accounts (FHSA, TFSA, RRSP, LIRA, non-registered) RESP (education savings) Life insurance Disability insurance Shared-ownership critical illness

Choose at least one.

Personal details

First nameRequired.

Middle name

Last nameRequired.

Former last name (if any)

Date of birthRequired.

Gender

Male Female

Required.

Marital status Required.

Contact

Street addressRequired.

CityRequired.

Province Required.

Postal codeRequired.

Country

Mobile phoneRequired.

EmailEnter a valid email.

Best time to reach you by phone

Citizenship and residency

CitizenshipRequired.

Country of birthRequired.

Legal status in Canada

Canadian citizen Permanent resident Work permit Study permit Convention refugee Live-in care program Other

Required.

Date you arrived in CanadaLeave blank if born in Canada.

Social Insurance NumberRequired.

SIN expiry date (temporary SINs only)

Are you a tax resident of the US or any country other than Canada?

Yes No

Required.

Are you a politically exposed person or the head of an international organization?

Yes No

Required.

Employment and income

Are you currently employed or self-employed?

Yes No

Required.

Annual income before taxRequired.

OccupationRequired.

Employer (or your corporation)Required.

Employer address

Highest level of education

No diploma High school Apprenticeship College Undergraduate certificate Bachelor's degree Postgraduate degree

Required.

Spouse or common-law partner

Needed for beneficiary designations, joint RESP subscribers and spousal coverage. Asked here once.

Full nameRequired.

Date of birthRequired.

Phone

Citizenship

Country of birth

Legal status in Canada

SIN

SIN expiry (temporary only)

Occupation

Employer

Annual income before tax

Section 2 of 7

Investment and registered accounts

For FHSA, TFSA, RRSP, LIRA and non-registered accounts you are opening or transferring.

Account types

FHSA TFSA RRSP LIRA Non-registered

Choose at least one.

How will you fund the account?

Regular contributions (weekly or monthly) Lump sums when I choose Transfer from another institution No contribution yet

Required.

Contribution frequency and amount

Proposed first deposit date

When do you plan to withdraw?

1–3 yrs 3–5 yrs 5–9 yrs 10+ yrs

Required.

Expected first withdrawal date

When do you plan to buy a home?

1–3 yrs 3–7 yrs 7+ yrs

Fixed assets (home, property)

Liquid assets (cash, investments)

Total liabilities (mortgage, loans)

Investment knowledge

Novice Fair Good Sophisticated

Required.

Other investments you currently hold

Stocks Bonds Mutual funds Segregated funds GICs Real estate

Risk tolerance

Low Low–medium Medium Medium–high High

Required.

Investment objective

Safety Income Growth Speculative

Required.

Account beneficiaries

Applies to every registered account you selected. Percentages across all beneficiaries should total 100%.

Section 3 of 7

RESP — education savings

For starting a new plan or transferring an existing one. Your own details and your spouse's were captured in Section 1.

Plan type

Individual — one plan per child Family — one plan for all children

Required.

Is this a transfer from another RESP?

Yes No

Required.

Will there be a joint subscriber?

Yes No

Required.

Is the joint subscriber your spouse or common-law partner named in Section 1?

Yes No

Joint subscriber — full name, date of birth, SIN

Does the joint subscriber live at your address?

Yes No

Joint subscriber address

Add a replacing subscriber?

Yes No

The person who takes over the plan if you die.Required.

Full name

Date of birth

Gender

Children (beneficiaries)

Household (for federal grants)

All children live at your address?

Yes No

All children are siblings?

Yes No

All children have the same primary caregiver?

Yes No

Primary caregiver's name (the person who receives the Canada Child Benefit)

The primary caregiver does not want the CRA to share family income with ESDC. (If yes, the Additional CESG and Canada Learning Bond cannot be paid.)

Yes No

Has the Canada Learning Bond already been requested in another RESP?

Yes No

All children have the same custodial parent?

Yes No

Custodial parent's name

Contributions

Initial contribution

Regular contribution on a set date Lump sum when I choose Transfer from another RESP Transfer from another iA contract (not an RESP) Cheque No initial deposit — grant catch-up only

Initial amount

Contribution start date

Ongoing contributions

Regular contribution on a set date Lump sums when I choose None planned

Ongoing amount and frequency

Section 4 of 7

Insurance

Life, disability and critical illness applications share most questions. Each is asked once here and reused across every carrier form.

4A — General

Is this a personal or business need?

Personal Business

Required.

Premium payment

Monthly Annually

Required.

Your role in the company

Sole owner My spouse and I are the sole owners One of several owners Employee

Who will own the policy?

Me (the life insured) Another individual A corporation — details in Section 5

Required.

First name

Middle initial

Last name

Date of birth

Country of birth

SIN

Gender

Tax residency

Legal status in Canada

Address

Phone

Relationship to you

4B — Insurance history

Do you have any existing life, disability or critical illness policies?

Yes No

Required.

For each policy: type, company, amount, personal or business, and whether it was issued in the last 12 months

Is another insurance application pending or planned with any other company?

Yes No

Required.

Plan type

Company

Month / year

Policy number (if issued)

Amount applied for

Total in force including this one

Has any application for life, critical illness, disability or long-term care insurance ever been declined, postponed, rated, cancelled or modified?

Yes No

Required.

Coverage type, company, year and reason

Have you ever declared bankruptcy, made a consumer proposal, had wages garnished or had any other major financial difficulty, whether discharged or not?

Yes No

Required.

4C — Lifestyle and hazards

Every carrier asks these eleven questions. Answered once here for all products.

Last use of tobacco or nicotine in any form (cigarettes, cigars, vaping, gum, patches, chewing tobacco, shisha, cannabis mixed with tobacco)

Never Past year 1–3 yrs ago 3–5 yrs ago 5+ yrs ago

In the next 12 months, do you plan to travel or live outside Canada, other than trips of 6 months or less to North America, the Caribbean or the EU?

In the last 12 months have you piloted an aircraft outside a commercial airline, or do you intend to in the next 12 months?

In the last 12 months have you taken part in hazardous sports (combat sports, motor racing, scuba, skydiving, hang-gliding, mountain climbing, back-country skiing or snowmobiling, or similar), or do you intend to in the next 12 months?

In the last 10 years, any major driving violation — impaired driving, refusal of a breathalyzer, suspension, driving while suspended, major at-fault accident?

In the last 3 years, four or more driving violations (parking excluded)?

In the last 10 years, have you been charged with, convicted of or incarcerated for a criminal offence?

In the past 12 months, have you used cannabis or hashish more than once a week on average?

Have you used cannabis or hashish in the last 5 years?

Have you ever used non-prescribed drugs or narcotics (ecstasy, cocaine, LSD, heroin, amphetamines, steroids, etc.)?

Do you drink alcohol (beer, wine, spirits)?

Have you ever been treated for drug or alcohol use, joined a support group, or been advised to cut down or seek treatment?

4D — Health

Height

Weight

In the past year, have you lost more than 10 lbs / 5 kg (excluding after childbirth)?

How much, and why?

Do you have a family doctor or clinic you use regularly?

Doctor or clinic name and location

Do you have any medical condition for which you have been or are being investigated, tested, monitored or treated, or for which you are awaiting results or treatment?

List each condition for which you were prescribed medication for more than 30 consecutive days (condition only, not the drug name)

For each: type of test, month and year, result, and any follow-up advised

Has a biological parent, brother or sister (living or deceased) ever had chronic kidney disease, polycystic kidney disease, Huntington's, ALS, heart disease, cardiomyopathy, heart attack, stroke, MS, Alzheimer's, Parkinson's, retinitis pigmentosa, muscular dystrophy, cancer, diabetes, or any other motor-neuron or hereditary disorder?

4E — Life insurance: temporary coverage eligibility

Six questions that decide whether the carrier can cover you from the day you apply.

Ever treated for, or any indication of, stroke, chest pain, cancer, tumours, chronic kidney or liver disease?

Ever treated for, or any indication of, heart or blood-vessel disease (high blood pressure excluded)?

Ever treated for AIDS, ARC or any immunological disorder?

In the last 90 days, admitted to a medical facility, or had a diagnostic test or surgery recommended or performed (normal childbirth excluded)?

In the last 12 months, absent from work 15 or more consecutive days due to illness or injury?

Ever had a life or critical illness application declined, postponed, rated or modified?

4F — Disability insurance

Do you work at least 21 hours a week on a regular, continuous basis — or at least 8 months a year and 1,050 hours?

Do you have more than one occupation?

Do you hold any other disability insurance (creditor group insurance excluded)?

In the last 12 months, have you submitted an application, paramedical exam or phone interview to iA Financial Group?

When could a paramedical nurse visit you at home?

4G — Shared-ownership critical illness

Have you sought medical attention, been treated for, or been told you have symptoms of any of the following?

Angina or heart attack (with or without bypass or angioplasty) Cancer or malignant tumour (any site) Stroke or transient ischemic attack COPD or emphysema Crohn's disease or ulcerative colitis diagnosed in the last 8 years Diabetes Hepatitis B or C (other than carrier) Major depression in the last 5 years, or bipolar disorder Rheumatoid arthritis or spondyloarthritis None of the above

Beneficiary of the return-of-premium-on-death rider — name, date of birth, gender, relationship

Section 5 of 7

Corporate owner

Shown because a corporation will own the policy or account.

Full legal name of the corporation (as on the Articles of Incorporation)Required.

Corporation email

Registered address

Shareholders and officers

Articles of Incorporation and Certificate of Incorporation

Section 6 of 7

Investor risk profile

Required by the carrier for any investment or RESP account. Your age and income are already on file, so only the remaining questions appear.

When do you plan to start withdrawing at least 25% of what you have saved?

Under 1 year 1–3 years 4–5 years 6–9 years 10+ years

Required.

Over the next five years, you plan to…

Make regular withdrawals from capital (Home Buyers' Plan, retirement) Withdraw all earnings and some capital Withdraw all earnings, keep capital intact Withdraw only part of the earnings Accumulate — no withdrawals

Required.

Net worth (assets minus liabilities)

Up to $25,000 $25,001–$50,000 $50,001–$100,000 $100,001–$200,000 Over $200,000

Required.

Knowledge of investments

Very low — just starting Low — I know some investments are riskier than others Moderate — I know the main types and their risks Advanced — I understand return potential and volatility over time Very advanced — I follow markets closely and know them in depth

Required.

Tolerance for a drop in value

Very low — preserving capital is the only goal Low — occasional drops up to 5% Moderate — short-term drops of 5–10% High — short-term drops of 10–20% Very high — a 20% drop is acceptable for long-term growth

Required.

You invest $10,000 for one year. Which range of outcomes after one year is acceptable?

Gains only: $10,000 to $10,300 $9,500 to $11,000 $9,000 to $11,500 $8,000 to $12,500

Required.

When did you last complete a financial plan?

When did you last complete an estate plan or will?

Financial objectives in your own words

Section 7 of 7

Documents and consent

Attach identification, review your answers, and sign off.

Government photo ID (driver's licence, passport, PR card)Required.

Second ID, if requested

Void cheque or direct-deposit form (for pre-authorized payments)

Any other document (immigration papers, existing policy statements)

Anything else your advisor should know before your session?

Review your answers

Consent

I confirm the information above is accurate and complete. I consent to Adautin Wealth Management Inc. collecting, using and sharing this information with the insurance and investment providers I am applying to, for the purpose of preparing and submitting my applications.

I agree to receive text messages, calls and emails from Adautin Wealth Management Inc. about my applications and accounts. Message frequency varies; message and data rates may apply. Reply STOP to opt out of texts.

Type your full legal name as your signatureRequired.

Profile received

Charles will review your answers before your session. If anything needs a follow-up, you will hear from him at the phone number or email you provided.