Exhibit 4.1


 




	
  

  	
  00XVHA 9th
  Floor, 100 University Avenue Toronto, Ontario M5J 2Y1 Telephone
  1-800-558-0046 www.computershare.com Use a black or blue pen. Print in
  CAPITAL letters inside the grey areas as shown in this example. A B C 1 2 3 X
  City Prov. / State Postal / Zip Code Apt. Street Name Street Number
  Registered Name in which account is held (eg. John Smith) Holder Account
  Number C Please complete the information fields below (print clearly) in full
  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. Reinvestment Enrollment - Participant Declaration Form 

  






 















	
  

  	
  00XVIB 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): 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 Common
  Shares, please mark the below box to enrol for dividend reinvestment. Full
  Dividend Reinvestment On all Common 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 Form 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 Reinvestment Enrollment - Participant
  Declaration Form a Corporation, Trust, Partnership, or an unincorporated Fund
  or Organization (Required documents enclosed, as applicable) 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 This account is not intended to be used by, or on behalf of, a
  3rd party. 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 Privacy Notice Computershare is committed to
  protecting your personal information. In the course of providing services to
  you and our corporate clients, we receive non-public personal information
  about you - from transactions we perform for you, forms you send us, other
  communications we have with you or your representatives, etc. This
  information could include your name, address, social insurance number,
  securities holdings and other financial information. We use this to
  administer your account, to better serve your and our clients’ needs and for
  other lawful purposes relating to our services. Some of your information may
  be transferred to servicers in the U.S.A. for data processing and/or storage.
  We have prepared a Privacy Code to tell you more about our information
  practices, how your privacy is protected and how to contact our Chief Privacy
  Officer. It is available at our website, computershare.com, or by writing us
  at 100 University Avenue, Toronto, Ontario, M5J 2Y1. Computershare will use
  the information you are providing in order to process your request and will
  treat your signature(s) as your consent to us so doing. Please return
  completed form to: Computershare, 9th Floor, 100 University Ave, Toronto
  Ontario M5J 2Y1 Signature 1 - Please keep signature within the box Signature
  2 - Please keep signature within the box Day Month Year Registered Name in
  which account is held (e.g. John Smith) TELQ