Total: Other fixed income securities Total: Growth securities Common shares Description Date of acquisition ACB ($) Annual dividend Quantity Market ($) Total ($) 1) 2) 3) 4) Total Perpetual preferred shares Description Date of acquisition ACB ($) Rate of return Quantity Market value ($) ($) 1) 2) 3) 4) Total Growth securities mutual Description Date of acquisition MER ACB ($) Number of units Market ($) Total ($) 1) 2) 3) 4) Total Income trusts Description Date of acquisition ACB ($) Annual distributions ($) Quantity Market value ($) Total ($)
1) 2) 3) Total Note: The ACB should be adjusted downward each year to reflect capital distributions. Other growth securities Total: NOTE 6: Tax-free savings account (TFSA) Liquid securities Savings bonds Issuer Series Interest rate Maturity Face value ($) Accrued ($) 1) 2) Total Term deposits or guaranteed investment certificates maturing in less than 1 year Financial institution Date of deposit Date of maturity Interest rate Accrued value ($) 1) 2) 3) Total Bonds maturing in less than 1 year Issuer Date of acquisition Cost of acquisition ($) Interest rate Maturity Market value ($) 1) 2) 3) market mutual funds
Description Date of acquisition ACB ($) Rate of return Maturity Quantity Market value ($) Total ($) 1) 2) 3) Total: Fixed income mutual funds Description Date of acquisition ACB ($) Rate of return Maturity Quantity Market value ($) 1) 2) 3) Total: Other fixed income securities Total: Growth securities Common shares Description Date of acquisition ACB ($) Annual dividend Quantity Market value ($) Total ($) 1) 2) 3) 4) Perpetual preferred shares Description Date of acquisition ACB ($) Rate of return Quantity Market value ($) Total ($) 1) 2) 3) 4)
Savings Issuer Series Interest rate Maturity Face value ($) Accrued value ($) 1) 2) Total Term deposits or guaranteed investment certificates maturing in less than 1 year Financial institution Date of deposit Date of maturity Interest rate Accrued value ($) 1) 2) 3) Bonds maturing in less than 1 year Issuer Date of acquisition Cost of acquisition ($) Interest rate Maturity Market value ($) 1) 2) 3) Total Money market mutual funds Description Date of acquisition MER ACB ($) Number of units Market value ($) Total ($) 1) 2) Total: Other liquid securities Total: Fixed-income securities Term deposits or guaranteed investment certificates Financial institution Date of deposit Date of maturity Interest rate Accrued value ($) 1) 2)
Common shares Description Date of acquisition ACB ($) Annual dividend Quantity Market value ($) ($) 1) 2) 3) 4) Total Perpetual preferred shares Description Date of acquisition ACB ($) Rate of return Quantity Market value ($) Total ($) 1) 2) 3) 4) Growth securities mutual funds Description Date of acquisition MER ACB ($) Number of units Market value ($) Total ($) 1) 2) 3) 4) Total Income trusts Description Date of acquisition ACB ($) Annual distributions ($) Quantity Market value ($) Total ($) 1) 2) Total Note: The ACB should be adjusted downward each year to reflect capital distributions. Other growth securities
Total: Total RRSP or RRIF: NOTE 15: Registered Pension Plan Defined benefits Participant rate Pension accumulation rate Earnings subject to contributions (S) Current value ($) Other features 1) 2) Defined contribution Participant rate Employer contribution rate Earnings subject to contributions (S) Market value ($) Other features 1) Investment characteristics: 2) Investment characteristics: NOTE 16: Locked-In Retirement Account or Life Income Fund Liquid securities Savings bonds Issuer Series Interest rate Maturity Face value ($) Accrued ($) 1) 2) Total Term deposits or guaranteed investment certificates maturing in less than 1 year Financial institution Date of deposit Date of maturity Interest rate Accrued value ($) 1) 2)
1) 2) 3) 4) Total Perpetual preferred shares Description Date of acquisition ACB ($) Rate of return Quantity Market value ($) Total ($) 1) 2) 3) 4) Total Growth securities mutual funds Description Date of acquisition MER ACB ($) Number of units Market value ($) ($) 1) 2) 3) 4) Income trusts Description Date of acquisition ACB ($) Annual distributions ($) Quantity Market value ($) Total ($) 1) 2) 3) Total Note: The ACB should be adjusted downward each year to reflect capital distributions. growth securities Total:
NOTE 22: Life, disability and other insurance contracts a) Life insurance Issuer Underwriting year Type of contract Owner Adherent Insured Beneficiary ($) Annual premium ($) Cash surrender value ($) Adjusted cost base ($) Capitalization fund Death benefit Comments: b) Disability insurance Issuer Underwriting year Premium ($) Waiting period Monthly income ($) % indexation Profession protected for (years) Other features Comments: c) Critical illness, long-term care insurance and other insurance coverage Issuer Underwriting year Premium ($) Insured capital ($) Illnesses covered Comments: