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SUMMARY OF Enrolling into your group
savings and retirement plan

ENROLMENT
HBPO CANADA INC.

Type of plan: Registered Pension Plan (RPP)
Contract number: 41368-001
Member number: 360
Contract issuer: Industrial Alliance Insurance and Financial Services Inc.
Identification
Ms. Lara Desha
Social Insurance Number

*** **5 647
Date of birth
June 24, 1986
General information
Correspondence language
English
Marital status
Common-law spouse
Spouse’s name
Mr. Moayad Al-khasawneh
Spouse’s date of birth

April 3, 1979
Contact information
2466 Chandler Road Apt. 2466
Windsor (ONTARIO)
N8W 4A8
226-506-7133
laradesha86@gmail.com
Method of receiving statements and other information about your group savings and retirement plan
By mail
Subscribe for the eNewsletter

Yes
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My Client Space access code
laradesha86@gmail.com
Your employment information

Hire Date
No value provided
Province of employment
No value provided
Plan membership start date

2023-04-01
Beneficiaries
Specific designation or Relationship to % Designation
trust member type
Jasmine Khasawneh Daughter 100 Revocable
Trustee
Name Phone Address
Moayad Khasawneh 2262606505 2466 Chandler Road
Investor profile
Moderate
Although they are careful, investors who have a Moderate profile are seeking long-term capital appreciation and a relatively stable investment income.
They seek stability and balance in their investments.
Investment Instructions
Expected age of retirement
65
Choice of investments
Pre-Built Solution: Moderate - ATTITUDE 2051-2055
Contributions through payroll deductions

0.00% of gross salary per pay period
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Signature and other important information
In order to ensure the confidentiality of your personal information in its possession, Industrial Alliance Insurance and Financial Services Inc. will establish
a file for the purposes of providing you with financial products and services. Your file will contain information about your application for the group
savings and retirement plan as well as information about any request concerning the execution of this contract. Access to this file is limited to Industrial
Alliance Insurance and Financial Services Inc. employees and agents responsible for file management, to persons you have authorized, and to persons
legally entitled to do so.
Your file will be kept in Industrial Alliance Insurance and Financial Services Inc. offices. You have the right to access the personal information contained
in your file, as well as to have any erroneous information corrected that you are unable to change directly on the Industrial Alliance Insurance and
Financial Services Inc. website or by any other means. To do so, you must send a request in writing to the following address:
Industrial Alliance Insurance and Financial Services Inc.

Privacy Officer
PO Box 1907, Station Terminus, Quebec City, QC G1K 7M3
iA Financial Group, its affiliates and their agents can access information about me in order to know me better, better meet my needs and offer the best
possible service and client experience. (If you do not wish to grant access to this information, please call us at 1-800-567-5670.)
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I, Lara Desha, have signed and hereby acknowledged on 2023-04-07 at 14:26 (ET) that the information provided in my enrolment form were accurate
and that I have read and understood the following terms of the contract:
• I appoint my employer as agent and authorize it to act on my behalf to deduct contributions from my salary, if applicable, as stipulated in the
contract and I appoint the contractholder or sponsor, as the case may be, as the authorized agent to act on my behalf for the purposes of my
participation in the contract, notably for collecting and submitting contributions as set forth in the contract, determining default investment
instructions and applying such instructions to my investments if I fail to provide any investment instructions and such default instructions have
been determined.
• I consent to the exchange and communication of my personal information between Industrial Alliance Insurance and Financial Services Inc., the
contractholder or sponsor and their authorized agents, including all representatives or brokers, for the purposes of administering the contract and
the services provided under the contract, and I authorize the collection, use and communication of my personal information for these purposes.
• I hereby confirm that I have read and understood the information documents on the present contract, including the information regarding
investment options and applicable interest rates before choosing my investment instructions and I understand my responsibilities.
• By agreeing to receive documents electronically, I agree to consult my email and transmit any email address change to Industrial Alliance
Insurance and Financial Services Inc. In the event of untransmitted change, Industrial Alliance Insurance and Financial Services Inc. cannot be
held responsible for not transmitting information electronically. Industrial Alliance Insurance and Financial Services Inc. can send me any
document by mail if it could not be sent to me electronically, as required by law, if it is deemed appropriate or if I request it upon payment of the
appropriate fees. This consent shall enter into force as of the date it is received and applies to all the group savings and retirement plans that I
have with Industrial Alliance Insurance and Financial Services Inc. For additional information, contact Industrial Alliance Insurance and Financial
Services Inc. in writing or by email at pension@ia.ca. Note that you will be able to unsubscribe from receiving electronic communications and
eNewsletters at any time.
Denis Ricard Sean O'Brien

President and Chief Executive Officer Executive Vice President, Group Benefits and Retirement Solutions
Industrial Alliance Insurance and Financial Services Inc. Industrial Alliance Insurance and Financial Services Inc.
Customer Service - Group Savings and Retirement

Business hours Telephone Address
Monday to Friday from 8 am to 8 pm (ET) 1-800-567-5670 522 University Avenue
Email Fax Toronto, ON M5G 1Y7
pension@ia.ca 1-866-395-5553
iA Financial Group is a business name and trademark of Industrial Alliance Insurance and Financial Services Inc.
ia.ca
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SUMMARY OF Enrolling into your group

savings and retirement plan

HBPO CANADA INC.

Social Insurance Number

Spouse’s date of birth

Subscribe for the eNewsletter

Your employment information

Plan membership start date

Contributions through payroll deductions

Industrial Alliance Insurance and Financial Services Inc.

Denis Ricard Sean O'Brien

Customer Service - Group Savings and Retirement

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