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1.4Owner 2Owner is:(An Owner must be at least 16 years old except must be at least 18 in Quebec) Insured 1 (skip to Contingent Owner) Other individual or entity – complete this section below Insured 2(skip to Contingent Owner)Full legal name of individual (first, middle, last) or corporation/entitySocial insurance number3 Male FemaleSame address as: Insured 1 Owner 1 Insured 2Address (do not complete address, city, province & postal code if the same as Insured 1 or 2 or Owner 1)Date of birth (mmm/dd/yyyy)CityPostal codePrimary telephoneProvinceAlternate telephoneRelationship to InsuredOccupationEmail address4If Trust, name of trusteeIf Trust, date of trust agreementContingent Owner for Owner 2: (Optional)Full legal name (first, middle, last) or corporation/entityDate of birth (mmm/dd/yyyy)Relationship to OwnerOwner 2 verificationTo comply with the Proceeds of Crime (Money Laundering) and Terrorist Financing Act, the identity of Owners must be verified andthe involvement of any third parties determined in section 1.5. For a document to be acceptable for identification purposes, it musthave a photo, a unique identifier number and must have been issued by a provincial, territorial or federal government.Document presented to verify identity:Document number Driver’s licence Passport Other, specify:Jurisdiction of issueExpiry date (mmm/dd/yyyy)Tax information (complete only if applying for permanent life insurance)To comply with the Canada-U.S. Enhanced Tax Information Exchange Agreement, Canadian financial institutions are required by lawto report information to the Canada Revenue Agency (CRA) on certain financial accounts held in Canada by U.S. persons. You havean obligation to notify us of any change in tax residency status.Are you a U.S. resident for U.S. tax purposes or a U.S. citizen? Yes NoIf yes, provide your U.S. Tax Identification Number (TIN).To comply with part XIX of Canada’s Income Tax Act, Canadian financial institutions are required by law to report information to theCRA on certain financial accounts in Canada held by tax residents of jurisdictions other than Canada or the US.Are you a resident for tax purposes of any jurisdiction other than Canada and the US? Yes NoIf ‘yes’, provide all of your jurisdictions of tax residence and each respective Taxpayer Identification Number (TIN):Jurisdiction of tax residence:TIN:If you do not have a TIN for any jurisdiction of tax residencethen please choose one of the following codes for each suchjurisdiction: A: You have applied for a TIN but have not yet received it B: T hat jurisdiction of tax residence does not issue TINs toits residents 3.C: Other (please specify reason):SIN required only if the Owner is applying for permanent life insurance.4. Pleasecomplete if the Owner would like electronic delivery of the insurance contract and related documents and/or for thepurposes described in the Agreements section of this Application.Application for Life & Critical Illness Insurance106184 Can 10/21Page 4

1.5Third Party determination(required if applying for permanent insurance)A third party is an individual or entity with or will have an interest in a policy but is not an Insured or an Owner. Some examples ofthird parties include: premium payor, power of attorney, executor, and trustee.Is a third party involved with this application for insurance, or will a third party pay the insurancepremiums or have the use of, or access to, the cash value of any policy applied for? If the answer isyes, provide the following information: YesFull legal name of third party (first, middle, last), or corporation/entityType of third party NoDate of birth (mmm/dd/yyyy)Relationship to Owner(s)Detailed occupation or nature of businessStreet addressCityProvincePostal codeRegistration number if a corporationJurisdiction of incorporationIf unable to provide the information above about a third party, provide details as to why:If there are several third parties to be disclosed, complete a separate Third Party Determination form 105815 CAN foreach one.1.6Multiple policiesYou must complete this section if you are applying for more than one policy with this application. You must also complete a separateSection 2 for each policy applied for. As an illustration is not part of any policy that may be issued, it cannot be accepted as asubstitute for completing any part of this application.Base insurance planPolicy AWhole Life :Term :Live Well Plus :Policy BWhole Life :Term :Live Well Plus :Policy CWhole Life :Term :Live Well Plus :Policy DWhole Life :Term :Live Well Plus :Base plan amountInsured under thebase planPolicy Owner Advantage Plus Non Par T10 T20 T30 T10 T20 T80 Insured 1 Insured 2 Owner 1 Owner 2 Advantage Plus T10 T20 T10 T20 Advantage Plus T10 T20 T10 T20 Advantage Plus T10 T20 T10 T20 Insured 1 Insured 2 Owner 1 Owner 2 Insured 1 Insured 2 Owner 1 Owner 2 Insured 1 Insured 2 Owner 1 Owner 2Application for Life & Critical Illness Insurance Non Par T30 T80 Non Par T30 T80 Non Par T30 T80106184 Can 10/21Page 5

1.7BeneficiariesRevocable/Irrevocable designations: All beneficiaries are revocable unless otherwise stated. However, in Quebec the designationof a legally married spouse of the Owner is irrevocable unless expressly stated to be revocable. Do not name a minor as anirrevocable beneficiary. Once an irrevocable beneficiary has been named, his or her written consent is required for changes asdescribed in 3 below; a minor cannot give that consent. For Live Well Plus, a beneficiary designation is only for the Return ofPremium on Death Benefit. A critical illness benefit payable is paid to the Owner.1.List the beneficiary relationship to the Insured (except in Quebec). In Quebec, list the beneficiary relationship to the Owner.2.Primary and Contingent Beneficiary Designations must total 100% respectively.3. If “irrevocable” is selected as the beneficiary type, certain transactions cannot be done without the consent of eachirrevocable beneficiary. The changes, requiring that consent, include revoking that beneficiary or changing their share andmay also include surrendering the insurance contract or changing the ownership.4. A trustee should be named to receive funds on the minor’s behalf (except in Quebec). In Quebec, the proceeds payable to aminor will be paid to the parent(s)/legal guardian.Beneficiaries – Policy A:NameTypeRelationshipDate of birth Share % Beneficiary Primary Contingent Primary Contingent Primary Contingent Primary Contingent Primary Contingent Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable IrrevocableIf Beneficiary is a minorNameTrustee nameRelationship of Trustee to Owner1.2. Same as Minor 13. Same as Minor 1 Same as Minor 24. Same as Minor 1 Same as Minor 2Beneficiaries – Policy B:NameTypeRelationshipDate of birth Share % Beneficiary Primary Contingent Primary Contingent Primary Contingent Primary Contingent Primary Contingent Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable IrrevocableIf Beneficiary is a minorNameTrustee nameRelationship of Trustee to Owner1.2. Same as Minor 13. Same as Minor 1 Same as Minor 24. Same as Minor 1 Same as Minor 2Application for Life & Critical Illness Insurance106184 Can 10/21Page 6

Beneficiaries – Policy C:NameTypeRelationshipDate of birth Share % Beneficiary Primary Contingent Primary Contingent Primary Contingent Primary Contingent Primary Contingent Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable IrrevocableIf Beneficiary is a minorNameTrustee nameRelationship of Trustee to Owner1.2. Same as Minor 13. Same as Minor 1 Same as Minor 24. Same as Minor 1 Same as Minor 2Beneficiaries – Policy D:NameTypeRelationshipDate of birth Share % Beneficiary Primary Contingent Primary Contingent Primary Contingent Primary Contingent Primary Contingent Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable Irrevocable Revocable IrrevocableIf Beneficiary is a minorNameTrustee nameRelationship of Trustee to Owner1.2. Same as Minor 13. Same as Minor 1 Same as Minor 24. Same as Minor 1 Same as Minor 21.8Charity Benefit beneficiary designation(For Term and Advantage Plus only)Each Term & Advantage Plus life insurance policy applied for will, if issued, include a Charity Benefit. The Owner(s) can designate aneligible beneficiary for that benefit now or at any time prior to the Insured’s death. If an eligible beneficiary is not designated prior tothe Insured’s death, no Charity Benefit will be paid. Eligible beneficiary means an organization registered as a charity with the CanadaRevenue Agency.Charitable organization nameRegistration numberStreet AddressCityApplication for Life & Critical Illness InsuranceProvincePostal code106184 Can 10/21Page 7

Policy: A B C DIf applying for more than one policy with this application, please complete a separate Section 2, Page 8 for each additional policy.2.1Plan & benefit – Term LifeType Single lifeAmount of Insurance Term 10Term 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Accidental Death Benefit Insured 1 Insured 2 Children’s Term RiderAmount for each child: Waiver of Premium Yes2.2 Joint first-to-die Term 20 Term 30 NoPlan & benefit – Live Well Plus Critical Illness InsuranceAmount of Insurance Live Well Plus T10Optional Riders Return of Premium on Surrender or Live Well Plus T20Expiry Rider Juvenile Critical Illness Rider2.3 Live Well Plus T80 Disability Waiver of Premium Rider Plan & benefit – Advantage Plus Participating Whole LifeBasic: Enhanced: Total: Dividend options Enhanced Insurance – complete the Enhanced and Total amounts above Paid Up Additions Dividends on Deposit Premium Reduction Cash PaymentPremium payment period Pay to 100Term 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Additional Payment Option (APO)(not available on 10-pay policies) Single payment: Scheduled payments: 20-pay 10-pay Monthly AnnualScheduled payments amount, shown above, will be added to the premium for the policyto determine the amount of each bill, if annual billing, or of each draft, if monthly PAD, iselected for payment of premium.Children’s Term RiderAmount for each child: Accidental Death Benefit Guaranteed Insurability Yes NoWaiver of Premium Yes NoOwner Waiver of Premium Yes No2.4Plan & benefit – Non Par Whole LifeAmount of Insurance Single life Joint first-to-die Joint last-to-die Life pay 20-payTerm 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Accidental Death Benefit Insured 1 Insured 2 Children’s Term RiderAmount for each child: Waiver of Premium YesApplication for Life & Critical Illness Insurance No106184 Can 10/21Page 8

Policy: A B C DIf applying for more than one policy with this application, please complete a separate Section 2, Page 8 for each additional policy.2.1Plan & benefit – Term LifeType Single lifeAmount of Insurance Term 10Term 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Accidental Death Benefit Insured 1 Insured 2 Children’s Term RiderAmount for each child: Waiver of Premium Yes2.2 Joint first-to-die Term 20 Term 30 NoPlan & benefit – Live Well Plus Critical Illness InsuranceAmount of Insurance Live Well Plus T10Optional Riders Return of Premium on Surrender or Live Well Plus T20Expiry Rider Juvenile Critical Illness Rider2.3 Live Well Plus T80 Disability Waiver of Premium Rider Plan & benefit – Advantage Plus Participating Whole LifeBasic: Enhanced: Total: Dividend options Enhanced Insurance – complete the Enhanced and Total amounts above Paid Up Additions Dividends on Deposit Premium Reduction Cash PaymentPremium payment period Pay to 100Term 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Additional Payment Option (APO)(not available on 10-pay policies) Single payment: Scheduled payments: 20-pay 10-pay Monthly AnnualScheduled payments amount, shown above, will be added to the premium for the policyto determine the amount of each bill, if annual billing, or of each draft, if monthly PAD, iselected for payment of premium.Children’s Term RiderAmount for each child: Accidental Death Benefit Guaranteed Insurability Yes NoWaiver of Premium Yes NoOwner Waiver of Premium Yes No2.4Plan & benefit – Non Par Whole LifeAmount of Insurance Single life Joint first-to-die Joint last-to-die Life pay 20-payTerm 10 Rider Insured 1 Insured 2 Term 20 Rider Insured 1 Insured 2 Term 30 Rider Insured 1 Insured 2 Accidental Death Benefit Insured 1 Insured 2 Children’s Term RiderAmount for each child: Waiver of Premium YesApplication for Life & Critical Illness Insurance No106184 Can 10/21Page 8

3.1Purpose of insuranceWhat are the main purposes of this insurance? Select all that apply. Income replacement Estate preservation Loan protection Buy-sell coverage Key person insurance Other, specify below:Details:3.2. Insurance historyEnsure all disclosure requirements are completed if this application for life insurance is intended to replace existing insurance. Notethat it is considered a replacement if you are replacing a Foresters policy with another Foresters policy.Do you have individual life, accidental death, critical illness or disability insurance in force orpending with Foresters or another insurer? If yes, complete the following table:Insured 1InsurerCategoryInsured Personal Business Personal Business Personal Business Personal Business Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2StatusYearissuedType of insurance In-force Pending In-force Pending In-force Pending In-force Pending Yes Insured 2No Yes NoAmount If you have pending life or critical illness insurance with other carriers, how much of the totalinsurance will be placed with those carriers?Insured 1Insured 2Life insurance Critical Illness insurance Will you stop paying premiums, reduce the amount of coverage or discontinue existing lifeinsurance coverage or an annuity if the insurance applied for in this application is issued?If yes, specify details below, and complete the Comparison Disclosure Statement orLife Insurance Replacement Declaration required in your province. YesInsuredAmountPlanInsurer Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 No Yes No Have you ever had an application for life, critical illness or disability insurance declined, rated, or modified? If yes, specify the insurer,the date and final decision below.Insured 1 Declined Rated ModifiedReason:Insurer:Type:Date:Insured 2 Declined Rated ModifiedReason:Insurer:Type:Date:Application for Life & Critical Illness Insurance106184 Can 10/21Page 9

Lifestyle questionsInsured 1Insured 23.3 F oreign Residency &TravelDo you expect, within the next 2 years, to change your residencefrom Canada or to travel outside of Canada or the United States,Caribbean Islands (excluding Haiti), Western Europe, Hong Kong,Australia or New Zealand?If yes to this question, please provide details in Section 3.11including the name of each country, total number of weeks per yearspent in each country, and purpose of each trip. Yes No Yes No3.4 Criminal OffencesHave you ever been charged or convicted of a criminal offence?If yes, identify and provide details for each charge and convictionin Section 3.11. Yes No Yes No3.5 M edications, drugsand alcoholIn the last 10 years, have you used a narcotic or controlled drugexcept as prescribed to you by a physician?If yes, complete a Drug Usage questionnaire Yes No Yes NoIn the last 3 years, have you consumed alcoholic beverages? If yes,specify:How many times per week? Yes No Yes No Yes No Yes NoHow many drinks per occasion?Have you ever received or been offered or advised to receivetreatment or counseling for, or to discontinue or reduce the use of,alcohol or drugs?If yes, complete the applicable Alcohol or Drug Usage Questionnaire.3.6 S moking & TobaccoUseWhen was the last time you used tobacco or nicotine based productsor smoking cessation aids?neverin the last 12 monthsin the last 24 monthsin the last 5 years If you only smoke cigars, how many have you smoked in the last 12months?Not applicable4 or less5 to 12more than 12 In the last 5 years have you used marijuana or hashish?If yes, please describe your usage:3.7 DrivingIf incomplete dates anddetails are provided, afollow-up will be requiredfor preferred underwritingclassification.1-3 times per week4-6 times per week7 times per week? (once per day)8 or more times per weekWithin the last ten years have you been charged or convicted of analcohol or drug related driving offence, refusing a breathalyzer, hadyour driver’s licence suspended or revoked or, excluding parkingviolations, had more than one driving offence? Yes No Yes No Yes No Yes NoIf yes to this question, provide month, year and details for each charge in Section 3.11. For speedingviolations, provide number of kilometers over the limit. Provide driver’s licence number and place ofissue if not provided in Section 1.3.3.8 AviationIn the last 2 years have you flown, or do you plan to fly, an aircraftas a pilot, student pilot or crew member?If yes, submit a completed Aviation Questionnaire. Yes No Yes No3.9 AvocationsIn the last 2 years have you engaged in, or do you plan to engage in,any of the following: Motorized racing, sky diving, scuba diving, hanggliding, mountain climbing, heli-skiing, CAT or back country skiing orsnowboarding, or any other hazardous or extreme activity or sport? Yes No Yes NoApplication for Life & Critical Illness Insurance106184 Can 10/21Page 10

Lifestyle questions continued3.10 Assisted livingInsured 1Insured 2Do you reside in a nursing home or nursing facility, assisted livingresidence, retirement home or senior living facility? Yes No Yes NoDue to a chronic illness or disease, do you require the use of awheelchair or are you bedridden? Yes No Yes NoRequire assistance with any of the following activities of daily living:taking medications, bathing, dressing, eating, or toileting? Yes No Yes No3.11 Additional detailsQuestionInsuredDetails Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2 Insured 1 Insured 2Application for Life & Critical Illness Insurance106184 Can 10/21Page 11

4.1Insured is a minorParent 1Parent 2What is the gross annual income earned by the minor’s parents/legal guardian? How much life and critical illness insurance do the minor’s parents/legal guardian have?If none – indicate why not under details below. How much life and critical

Application for Life & Critical Illness Insurance 106184 Can 10/21 Page 3 1.3 Owner 1 (An Owner must be at least 16 years old except must be at least 18 in Quebec) Owner is: Insured 1 (skip to Contingent Owner) Insured 2 (skip to Contingent Owner) Other individual or entity - complete this section 1.3 below Full legal name of individual (first, middle, last) or corporation/entity Male