Branch Information

Branch Name: Member Number: *

Holder Information

First Name: *
Middle Name:
Last Name: *
Birthdate (dd/mm/yyyy): *
Social Insurance Number: *
 No Spaces
(surname, birthday and SIN must match CRA records)
Address: *
City: *
Province: Postal Code: *
No Spaces eg: e3e3e3

Contact Information

Home Phone: * Cell Phone: Office Phone: eg: 902 555 1234
Email: *
Confirm Email: *

Investment Details

Your personal account number to debit: *
Indicate your account type and member number to be debited

Select an Investment Option:*
Fixed Rate TFSA Minimum Investment

*the rates are subject to change without notice.
Amount of Contribution:*

Please Review Carefully and Accept Below

TO: Concentra Trust - Trustee

  • I hereby apply for participation in the above mentioned Tax-Free Savings Account (TFSA) in accordance with the Declaration of Trust supplied to me.
  • I request the Trustee to file an election to register my qualifying arrangement as a TFSA under the Income Tax Act (Canada).
  • I request that this contribution, and any subsequent contributions, be deposited in the Credit Union named above by the Trustee and I acknowledge that the terms and conditions of such deposits have been and will be agreed upon between myself and the Credit Union and that such deposits will be held by the Trustee.
  • I hereby acknowledge that I am solely responsible for determining the amount of contribution to the TFSA.
  • I hereby agree to notify the Trustee in the event that I am no longer a resident of Canada.
  • I hereby acknowledge that I am at least 18 years of age.
  • I understand and acknowledge that the personal information contained herein is being collected by Concentra Trust (the "Trustee") and that by signing below, I confirm that I have read and consent to the terms of the "Concentra" Privacy Policy located on the Concentra website at or by contacting the Trustee at 1-800-788-6311. "Concentra" refers to Concentra Bank and its wholly-owned subsidiary Concentra Trust. I confirm that the information provided herein is true and accurate and I agree to make the above named Credit Union, on behalf of the Trustee, aware of any changes to the personal information contained on this application form.

Do you accept?: *