Survey must be completed by August 29, 2025, at 12:00 pm PST

Section A - Member Information

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* 1. Full Legal Name:

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* 2. Date of Birth:

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* 3. Status Number:

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* 4. Address:

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* 5. Phone Number(s):

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* 6. Email Address:

Section B - Distribution Election

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* 7. Please indicate how you wish to receive your entitlement:

Note: if you do not indicate a preference, the default will be a cash payment.
Section D - Children/Minor Beneficiaries

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* 8. Please list all children under the age of 19 for whom you are the parent or legal guardian.

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* 9. Please add any additional children entries here. Be sure to include their full name, date of birth, status number and their relationship to you:

Note: Minor beneficiaries' entitlements will be placed in a Minors' Trust with Scotiatrust as Trustee and Jarislowsky Fraser as Investment Manager. Funds will be held until age 19 subject to financial literacy requirements.
Section E - Declaration & Consent

I certify that the information provided above is true and complete to the best of my knowledge. I consent to the use of this information by the Nation to update the membership list.

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* 10. Do you wish to be put on a UFN member E-mail distribution list for future community updates?

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* 11. Signature (*Please type your name in if this is done electronically)

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* 12. Date:

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* 13. Signature of Parent/Guardian (if applicable):

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