The purpose of this deed is to change the beneficiary under a power of appointment trust.

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1 This trust deed may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Deed appointment to change the Deed The purpose this deed is to change the under a power appointment trust. It cannot be used to change a under a bare or discretionary trust. The appointment is revocable which means that if it is used to change a under a trust dated before 22 March 2006, the trust will be brought into the relevant property tax regime and the previous will be treated as making a gift with reservation. If this is not what you require, we strongly recommend that you seek pressional advice before proceeding. This deed is provided as a draft to be considered by you and your pressional adviser. It is provided solely for general consideration. Notes The deed must be completed by the person(s) who have the power appointment (the Appointor) under the terms the Trust (this is normally the Settlor but may also be the Trustees you will need to refer to the Trust)

2 In this deed the singular includes the plural and the masculine includes the feminine (and vice versa) where the context so admits. Deed Appointment This Deed is made on the You must date this deed using the date that the last person signs BY The Appointor(s) named below. WHEREAS 1. This deed appointment is in addition to and in accordance with the declaration trust ( the Trust ) for the policy ( the Policy ) shown in the Schedule on page The Appointor wants to revoke any appointments made previously (where they are capable being revoked) in accordance with the Trust. 3. The Appointor wants to exercise his power appointment in the following way. NOW THIS DEED WITNESSES 1. Any appointments made previously (that can be revoked) are revoked 2. That until such time as any new appointments are made (and this deed is revoked), the Trustees shall hold the Policy in trust with an interest in possession for the benefit the beneficiaries named below: Please note: The settlor the Trust cannot be named as a. The total s must equal 100%. The Beneficiaries date birth % date birth % date birth % Deed appointment to change the 2

3 and tick small boxes where appropriate Schedule Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Please tick as appropriate Description policy Policy number Policy date We certify that: This instrument falls within Category L in the Schedule to the Stamp Duty (Exempt Instruments) Regulations Data Protection Notice The information you have provided in this form will be used in accordance with our data protection notice. A copy the relevant notice for Canada Life Limited can be found on or by request on , those for both Canada Life International Limited and CLI Institutional Limited can be found on and for Canada Life International Assurance (Ireland) DAC on or by request on Signatures In witness the Appointor has executed this deed on the day and year mentioned above. Deed appointment to change the 3

4 Deed appointment to change the 4

5 Canada Life Limited, registered in England no Registered fice: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. Telephone: Fax: Member the Association British Insurers. Canada Life International Limited, registered in the Isle Man no Registered fice: Canada Life House, Isle Man Business Park, Douglas, Isle Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member the Association International Life Offices. CLI Institutional Limited, registered in the Isle Man no C. Registered fice: Canada Life House, Isle Man Business Park, Douglas, Isle Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member the Association International Life Offices. Canada Life International Assurance (Ireland) DAC, registered in Ireland no Registered fice: Irish Life Centre, Lower Abbey Street, Dublin 1, Ireland Telephone: +44 (0) Fax: +44 (0) Member the Association International Life Offices. Canada Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Canada Life International Limited and CLI Institutional Limited are Isle Man registered companies authorised and regulated by the Isle Man Financial Services Authority. Canada Life International Assurance (Ireland) DAC is authorised and regulated by the Central Bank Ireland. This paper is made from recycled materials CTU10 616R/2

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