Please complete this form, print it, and mail it to:

Scarboro Missions
2685 Kingston Rd.
Scarborough, ON
Canada
M1M 1M4

Please note: Government regulations require that you send this application with proof of your age, such as a photocopy of your birth certificate, driver's licence, or passport.

Name:
Address:
City:
Prov./State:
Postal/Zip:
Country:
Birthdate:
Social Insurance #:
Telephone:
 
Please check desired type of annuity
Individual     Joint
 
For a joint annuity, please complete the following:
Spouse's name:
Spouse's Birthdate:
Social Insurance #:
 
Amount of Annuity:
I would like to receive my payments:
Annually Semi-annually Quarterly
Monthly
I would like my payments to be:
mailed to me    deposited in my bank account
 
Name of Bank:
Bank Address:
City:
Prov./State:
Postal Code:
Account #:
   
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