telus_ex4-1.htm


     

     

    
      Exhibit
4.1

      
 

      
        	
                

              	
                 
      

                9th
      Floor, 100 University Avenue  

                Toronto,
      Ontario  M5J 2Y1   

                Telephone  1-800-558-0046  
      

                www.computershare.com  
      

                 

              


      

      


      
        	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      	
                Holder
      Account Number

              
	
                Use
      a black or blue pen. Print in
      CAPITAL  letters  inside  the  grey
      

              	 
      	
                A   B   C

              	 
      	
                1   2   3

              	 
      	
                X

              	 
      	
                C

              	
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	 areas
      as shown in this example.	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 


      

      


      
        	
                Please
      complete the information fields below (print clearly) in
    full

              
	
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                Apt.

              	
                Street
      Number

              	
                Street
      Name

              
	
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                City

              	 
      	
                Prov.
      / State

              	 
      	
                Postal
      / Zip Code

              
	
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                Reinvestment
      Enrollment - Participant Declaration
Form

              


      

       

      The
Proceeds of
Crime (Money Laundering) and Terrorist
Financing Act (Canada) and the Regulations
made thereunder (collectively, the “Act”) require that
Computershare Trust Company of Canada collect and record specified information
on accounts it opens for individuals or entities 

      under
a Plan.  Please
read Instructions below before completing the Reinvestment Enrollment -
Participant Declaration Form on the reverse.

       

      INSTRUCTIONS

      In
order that Computershare may comply with its legal obligations under the Act,
this declaration and enrollment form must be completed in full and signed by all
registered holder(s). Otherwise Computershare cannot process your
enrollment.

       

      Part
A – PARTICIPANT DECLARATION


       

      If
a plan account is registered to:

      
        	
                1)

              	
                an individual account holder or
      more than one holder – each individual must complete their Date of
      Birth and Principal Business or Occupation.

              
	 
      	 
      
	
                2)

              	
                a Corporation – it must mail or
      hand-deliver this declaration and enrollment form along with a copy of its
      official corporate records relating to the authority to operate this
      account. Neither Date of Birth nor Principal Business or Occupation is
      required to be completed.  Mark the 

                applicable
      account holder status box.

              
	 
      	 
      
	
                3)

              	
                a Trust, Partnership, or an
      unincorporated Fund or Organization – Complete the field for
      Principal Business or Occupation.  Date of Birth is not required
      to be completed. Mark the applicable account holder status
      box.

              


      

       

      As
space on the front of this form is limited to 2 holder declarations and
signatures, photocopies of this form may be made if required.

       

      Part
B – THIRD PARTY DETERMINATION

       

      In
order that Computershare may comply with its legal obligations under the Act,
you must check one of the two boxes provided with regard to any third party
interest in the account, and fill in the additional fields if required,
including a description of the relationship. For example, are you an agent,
custodian, attorney, or legal guardian, or otherwise
holding the account on behalf of a spouse, relative, business partner or
friend?

       

      Part
C – ENROLLMENT PARTICIPATION

       

      This
section must be completed to process your request for enrollment

       

       

      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    
      


      Registered
Name in which account is held (e.g. John Smith)

      
        	 
      	
                TELQ

              


      

      


      
        	
                Reinvestment
      Enrollment - Participant Declaration
Form

              


      

      


      
        	
                A
      –

              	
                PARTICIPANT
      DECLARATION

              
	 
      	 
      
	 
      	
                I/We,
      the account holder(s) named above, hereby certify as
    follows:

              


         

        	 
      	
                1)
      Date of Birth:

              	 
      	 
      	
                Principal
      Business or Occupation:

              	 
      
	 
      	 
      	
                Day

              	
                Month

              	
                Year

              	 
      	 
      	
                (e.g.
      cashier, student, retired, accounting firm)

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                2)
      Date of Birth:

              	 
      	 
      	
                Principal
      Business or Occupation:

              	 
      
	 
      	 
      	
                Day

              	
                Month

              	
                Year

              	 
      	 
      	
                (e.g.
      cashier, student, retired, accounting firm)

              
	 
      	 
      	 
      	 
      	 
      	 
      	 
      	 
      
	 
      	
                and
      that the account holder is (Check the appropriate account
      holder status box, if applicable):

              


         

        	 
      	o	
                a
      Corporation, Trust, Partnership, or an unincorporated Fund or Organization
      (Required documents enclosed, as applicable)

              	 
      	o	
                a
      Financial Entity or Securities Dealer and is exempt from Third Party
      Determination in Section B below.  (Proceed to part C)

              


      

      


      
        	
                B
      –

              	
                THIRD
      PARTY DETERMINATION –
      Check one of the two boxes below.  If the second box is marked,
      you must provide the information

              


         

        	 
      	o	
                This
      account is not intended to be used by, or on behalf of, a 3rd
      party.

              	 
      	o	
                This
      account is intended to be used by, or on behalf of, a 3rd party and I have
      completed the required information fields
below.

              


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                Name
      of 3rd party:

              	 
      


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                Address
      of 3rd party:

              	 
      


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                Date
      of Birth of 3rd party (if an individual):

              	 
      


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                Nature
      of Principal Business or Occupation of 3rd party:

              	 
      


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                If
      3rd party is a Corporation, provide incorporation number and place of
      issue:

              	 
      


      

      


      
        	 
      	 
      	 
      	 
      	 
      	
                Describe
      relationship between account holder and 3rd party, in respect of the
      account:

              	 
      


      

      


      C
– ENROLLMENT PARTICIPATION

       

      Please
refer to the plan prospectus or brochure before enrolling or sending optional
cash contributions.

      


      To
have the cash dividend on all shares registered in the name(s) of the
undersigned reinvested to purchase TELUS Corporation Non-Voting Shares, please
mark the appropriate box(es) for each class of shares you want to enrol for
dividend reinvestment.

      


                 Full Dividend
Reinvestment

       

      
        	 
      	o	
                On
      all Common Shares

              	o	
                On
      all Non-Voting Shares

              


      

      


      Please Note: In order to make any optional cash purchases, your account must be enrolled in the Dividend Reinvestment Plan and comply with Federal Anti-Money Laundering and Terrorist Financing Legislation. Please review the
instructions provided in the Optional Cash Purchase – Participant Declaration
and Contribution Voucher and, complete and comply as
applicable.

      


      This
form should ONLY be used for TELUS
Corporation.

      


      Please
note: No interest will be paid on the funds held pending purchase. Notification
of receipt of cheques will not be mailed to you.

      


      By
participation in the plan, I agree to be bound by the terms and conditions of
the prospectus or brochure that governs the plan. I have read and fully
understand the terms and conditions of the prospectus or brochure. I further
agree that my participation in the plan will continue until I notify
Computershare in writing that I desire to terminate my participation in the
plan. Upon providing such notification, I acknowledge that my withdrawal from
the plan will be subject to the terms and conditions of the prospectus or
brochure that governs the plan.

      


      To be valid, this form must be signed by all registered shareholders.  Signatures by an
attorney or persons signing as executers, administrators, or trustees must be
accompanied by adequate proof of appointment. If you do not sign and return this
form , you will continue to receive dividend payments in cash

      


      
        	
                Signature
      1 - Please keep signature within the box

              	 
      	
                Signature
      2 - Please keep signature within the box

              	 
      	
                Day

              	
                Month

              	
                Year

              
	 
      	 
      	 
      	 
      	 /
      	 /
      	 
      


      

      


      Privacy
Notice

       

      Computershare
is committed to protecting individuals’ personal information. In the course of
providing our services, we receive non-public personal information - from
transactions we perform for investors, forms sent to us, other communications we
have with investors or representatives, etc. This information could include
name, address, social insurance number, social security number, securities
holdings and other financial information. We use this to administer investor
accounts, to better serve investors’ and clients’ needs and for other lawful
purposes relating to our services. We have prepared a Privacy Code to tell you
more about our information practices and how personal information is protected.
It is available at our website, www.computershare.com, or by writing us at 100
University Avenue, Toronto, Ontario, M5J 2Y1.

      


      
        	
                Please
      return completed form to:

              	
                Computershare,
      9th  Floor, 100 University
      Ave, Toronto Ontario M5J 2Y1