Fillable Printable Power of Attorney Identification Form - Prince Edward Island

Power of Attorney Identification Form - Prince Edward Island

618-07-592E (09/01/2014)

Power of Attorney Identification Form

Client Information

Power of Attorney Information

Please provide details of two original pieces of identification (including one with photo) for each Power of Attorney authorized to transact on the account.

The identification must be viewed and verified by the Guarantor signing below.

Please refer to the Personal Identification Requirements Checklist on page 2 for a list of acceptable identification documents. For additional Power of Attorneys

please attach additional forms.

First NameLast Name

Page 1 of 2

Address

Account number(s):

Guarantor Signature

Print Name

Date (mm/dd/yyyy)

Power of Attorney Signature

Date (mm/dd/yyyy)

I hereby certify that I have personally met with the individual identified as Power of Attorney on this form, that I have seen the original identification records listed

herein, and that I have witnessed the individual sign this form.

Acceptable Guarantors

• Lawyer

• NotaryPublic

• CommissionerofOaths

• Medallion“Stamp”programmember

• Financialinstitution(bank/trust/securitiesdealer)

 –mustaffix“SignatureGuarantee”stamp

Initial

Power of Attorney #1

Last Name

Home Address

City

Province

Postal code

City

Province

Postal code

Type of ID

ID Number

Issued by

Expiry Date

Date of birth (mm/dd/yyyy)

Home phone number

Work phone number

Type of ID ID Number Issued by

Expiry Date

Name of Employer

Occupation

InitialFirst Name

Address of Employer

( ) ( )

First NameLast Name

Advisor Information

Advisor/Agent Number

Dealer Information (optional)

Dealer Number

Dealer Name

GUARANTOR’S CERTIFICATE OF SIGNATURE AND IDENTITY VERIFICATION (see list of acceptable Guarantors below)

Affix stamp or seal in the space below (not applicable if Guarantor is a lawyer)

YYYY

618-07-592E (09/01/2014)

Power of Attorney Identification Form

Page 2 of 2

Print Name

Date (mm/dd/yyyy)

Guarantor Signature

Power of Attorney Signature

Date (mm/dd/yyyy)

I hereby certify that I have personally met with the individual identified as Power of Attorney on this form, that I have seen the original identification records listed

herein, and that I have witnessed the individual sign this form.

Acceptable Guarantors

• Lawyer

• NotaryPublic

• CommissionerofOaths

• Medallion“Stamp”programmember

• Financialinstitution(bank/trust/securitiesdealer)

 –mustaffix“SignatureGuarantee”stamp

Personal Identification Requirements Checklist

• Driver’sLicenceissuedinCanada

• Passport

• CerticateofIndianStatus-issuedbytheGovernmentofCanada

• CanadianPermanentResidenceCard

• QuebecHealthCard(withphotoIDandexpirationdate)

• IdenticationCards-issuedbytheProvince(notavailablein

Quebec)

[Note: Health Cards in Quebec must be offered by clients -

they cannot be requested]

• Certificate of Canadian Citizenship or Naturalization

•ProvincialHealthCard(withoutphotoIDand/orexpirydate)

• BirthCerticate-issuedinCanadaonly(bytheGovernment,Churchissue

not accepted)

• Social Insurance Card - issued by the Government of Canada

• MajorCreditCard(bearingthenameoftheapplicantandtheirsignature)

• College/University Student ID Card (bearing the name of the applicant, signature

and photograph)

• Firearms Licence - issued federally with photo ID

• CanadianForcesIdenticationCard(bearingindividualsname,photoand

expiration date)

•CNIBCard

• NEXUSCard(bearingtheapplicant’sname,passportnumberandphotograph)

[Note: Health Cards are not acceptable identification for Manitoba, Ontario,

Nova Scotia or Prince Edward Island]

Details of two pieces of valididenticationarerequiredforeachpowerofattorneyforpersonal accounts.

Each form must clearly indicate the ID type, unique ID number, issuer, and the expiration date (if applicable).

Type 1 Documentation

Details of the following are required:

• OnepieceofType1DocumentationandonepieceofType2Documentation

• Two pieces of Type 1 Documentation

Type 2 Documentation

Power of Attorney #2

Last Name

Home Address

City

Province

Postal code

City

Province

Postal code

Type of ID

ID Number

Issued by

Expiry Date

Date of birth (mm/dd/yyyy)

Home phone number

Work phone number

Type of ID ID Number Issued by

Expiry Date

Name of Employer

Occupation

InitialFirst Name

Address of Employer

( ) ( )

GUARANTOR’S CERTIFICATE OF SIGNATURE AND IDENTITY VERIFICATION (see list of acceptable Guarantors below)

Affix stamp or seal in the space below (not applicable if Guarantor is a lawyer)

YYYY