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STEP #1: CONFIRM TOTAL GREAT-WEST LIFECO INC. SHARE HOLDINGS*

TOTALS SHARES

Total Book Shares

Total Shares

STEP #2: TENDER YOUR SHARES**

CHECK ONLY ONE BOX TO INDICATE HOW MANY SHARES YOU WISH TO TENDER

ALL ABOVE SHARES PARTIAL TENDER*** ______________________________

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Form NR301 - Declaration of eligibility for benefits under a tax treaty for a non-resident taxpayer

Signature of non-resident taxpayer or authorized person

Non-Canadian Tax Identification Number

Certification and UndertakingThis form must be signed and dated for us to accept as proper certification.• Icertifythattheinformationgivenonthisformiscorrectandcomplete.• Icertifythatthenon-residenttaxpayeristhebeneficialownerofallincometowhichthisformrelates.• Icertifythattothebestofmyknowledgeandbasedonthefactualcircumstancesthenon-residenttaxpayerisentitledtothebenefitsofthetaxtreatybetweenCanadaandthecountry

of residence indicated in “Your Country of Residence”, on the type of income being declared.• IundertaketoimmediatelynotifythepayerthroughwhichIderiveincome,andtowhomIamsubmittingthisform,ofanychangestotheinformationprovidedonthisform.

Your Country of Residence

Type of Income Being Declared

Send this form to Computershare. Do not send to the Canada Revenue Agency.

Name and Position/Title of authorized person

Use a black pen. Print in CAPITAL letters inside the grey areasasshowninthisexample.

A B C 1 2 3 X

Dear Shareholder: Please read the reverse for directions on completing this form.

Date (mm/dd/yyyy)Sign Here

Interest,Dividends,and/or Royalties

Trust Income Other _____________________________________________ Specify income type

Individual

Recipient Type(s) and Canadian Tax Number(s) CompletethissectiononlyifyouhaveaCanadianTaxNumber

Corporation

Enter your Canadian Social Insurance Numberorindividualtaxnumber.

Enter your corporation’s business number.

Enter the trust’s account number.Trust

R C

T

Holder Account Number

G W O Q 4 N R 3 0 127

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Important Information

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Why should I complete this form?ItisComputershare’sresponsibilitytowithholdandremitPartXIIItaxattheappropriaterateandyouareliableforanydeficiency.Forthisreason,acompletedformNR301willallowustoapplyareducedrateofwithholdingtax,ifapplicable,otherwise,thehighestratewillberemittedtotheCanadaRevenueAgency(CRA).

Is this the right form for me?Usethisformifyouareanon-CanadiantaxpayerresidinginacountrywithwhomCanadahasataxtreaty,andyouareeligibletoreceivethereducedrateoftaxorexemptionprovidedbythetreatyonallorcertainincome,andyou:

• receiveincomesubjecttoPartXIIIwithholdingtax,suchasinvestmentincome,pension,annuities,royalties,andestateortrustincome,andthewithholdingtaxrateis reduced by the tax treaty, or

• arecompletingformsT2062,Request by a Non-Resident of Canada for a Certificate of Compliance Related to the Disposition of Taxable Canadian Property or T2062A, Request by a Non-Resident of Canada for a Certificate of Compliance Related to the Disposition of Canadian Resource or Timber Resource Property, Canadian Real Property (Other Than Capital Property), or Depreciable Taxable Canadian Property to request a certificate of compliance for the disposition of treaty protected property, or

• deriveincomeofanykindthroughapartnershiporhybridentityanditasksyoutocompleteformNR301tosupportadeclarationbythepartnershiporhybridentity.

Do not use this form:• tosupportexemptionsfromtaxunderArticleXXIoftheCanada–U.S.taxtreaty.YoumustapplytotheCRAforaLetterofExemption.RefertoguideT4016,

Exempt U.S. Organizations – Under Article XXI of the Canada – United States Tax Convention;

• tosupportexemptionsunderataxtreatythatdoesnottaxpensionincomeifthetotalamountreceivedfromallpayersislessthanacertainthresholdamount,orinothersituationswhereformNR5,Application by a Non-Resident of Canada for a Reduction in the Amount of Non-Resident Tax Required to be Withheld, is applicable. See guide T4061, NR4 – Non-Resident Tax Withholding, Remitting, and Reporting for more information on pension exemptions.Inthesecases,youhavetofileformNR5toreceivealetterauthorizingareductioninwithholdingtaxonpensionincome;

• tosupportexemptionsfromPartXIIIwithholdingtaxthatareprovidedforintheIncome Tax Act,suchasfullyexemptinterestasdefinedinsubsection212(3);tosupportarm’slengthinterestpaymentsthatarenotcapturedbyparagraph212(1)(b);ortosupportreductionsofthePartXIIIwithholdingtaxonrentalincomewhenthe non-resident makes an election under Section 216. In these circumstances, you do not complete this form, since the exemption or reduction is in the Income Tax Act rather than in one of Canada’s tax treaties.

For more information on the NR302 and NR303 Forms, please go to http://www.cra-arc.gc.ca/formspubs/frms/nr301-2-3-eng.html

Instructions on completing this formNon-Canadian Tax Identification Number:Enterthetaxidentificationnumberthatyouuseinyourcountryofresidence,ifyouhaveone.Forindividualswhoareresident in the United States, this is your Taxpayer Identification Number (TIN).

Your Country of Residence:Indicateyourcountryofresidence.YoumustbearesidentofthecountryasdefinedinthetaxtreatybetweenCanadaandthatcountry.

Type of Income Being Declared:Enterthetypesofincomebeingpaidforwhichyouareeligiblefortaxtreatybenefits(suchasanexemptionfromtaxinCanadaorareducedwithholdingtaxrate).Note:Income,includinginterestanddividendincome,paidbyatrust(otherthanadeemeddividendpaidbyaSpecifiedInvestmentFlow-Throughtrusttowhichsubsection104(16)applies)toanon-residentisconsidered“trustincome”undertheIncomeTaxActandCanada’staxtreaties.

Recipient Type and Canadian Tax Number:Ticktheappropriatetypeofnon-residenttaxpayerandprovideaCanadiantaxnumber,ifyouhaveone.

Certification and Undertaking:Thisformmustbesignedanddatedby: • thenon-residenttaxpayerinthecaseofanindividual; • anauthorizedofficerinthecaseofacorporation; • thetrustee,executor,oradministratorifthepersoncompletingtheformisatrust; • anauthorizedpartnerinthecaseofapartnership.

Joint Partnerships or Multiple Name Registrations: Complete one form per holder in the partnership or registration.

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SignatureofU.S.Person-Pleasekeepsignaturewithinthebox

Taxpayer Identification Number (TIN)A

Social Security Number Employer Identification Number

OR

B Federal Tax ClassificationCheckappropriatebox(required);checkonlyONEofthefollowingboxes:

Note: For a single-member LLC that is disregarded, check the appropriate box belowfor the tax classification of the single-member owner.

Individual/SoleProprietor or Single-Member LLC

C Corporation S CorporationTrust/Estate

C Exemptions

Ifyouareexemptfrombackupwithholding,enterinthis box any code that may apply to you. See Exempt Payee Codes on the back of this form.

IfyouareexemptfromFATCAReporting,enterinthisbox any code that may apply to you. See Exemption fromFATCAReportingCodesonthebackofthisform.

D CertificationUnderpenaltiesofperjury,Icertifythat:1.ThenumbershownonthisformismycorrectTaxpayerIdentificationNumber,and2.Iamnotsubjecttobackupwithholdingbecause:(a)Iamexemptfrombackupwithholding,or(b)IhavenotbeennotifiedbytheInternalRevenueService(IRS)thatIamsubjecttobackupwithholdingasaresultofafailuretoreportallinterestordividends,or(c)theIRShasnotifiedmethatIamnolongersubjecttobackupwithholding,and

3.IamaU.S.citizenorotherU.S.person(definedonreverse).4.TheFATCAcode(s)enteredonthisform(ifany)indicatingthatIamexemptfromFATCAreportingiscorrect(definedonreverse).Certification Instructions.Youmustcrossoutitem2aboveifyouhavebeennotifiedbytheIRSthatyouarecurrentlysubjecttobackupwithholdingbecauseyouhavefailedtoreportallinterestanddividendsonyourtaxreturn.

Enter your TIN for the above registered name and address in the appropriate box. For individuals, this is your Social Security number (SSN).For other entities, it is your Employer Identification Number (EIN). COMPLETE ONLY ONE BOX.

Send form to Computershare. Do not send to the IRS.

This form must be signed and dated for us to accept as proper certification.Daytime Telephone Number

Limited Liability Companyor Other Classification

If you are an LLC or Other Classification, do not complete this form. You must complete an IRS Form W-9. This form can be found on the IRS website at www.irs.gov. See “Limited Liability Company or Other Classification” on the back of this form for more information.

Use a black pen. Print in CAPITAL letters inside the grey areasasshowninthisexample.

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Dear Shareholder:Our records indicate that your U.S. Social Security Number or Employer Identification Number is not certified. If this Form W-9 is not completed and returned, your account may be subject to backup withholding at the applicable tax rate on all dividends and sale proceeds. For joint tenant accounts, the TIN provided must belong to the first owner listed above to avoid backup withholding.

Date (mm/dd/yyyy)Sign Here

Partnership

Exempt Payee Code (if any) Exemption from FATCA Reporting Code (if any)

å

Holder Account Number

Date Issued:

G W O Q 4 U S W 9

Form W-9 Request for Taxpayer Identification Number and Certification

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How to complete this form

TheInternalRevenueService(IRS)requiresustowithholdtaxesfortheapplicablerateofbackupwithholdingforU.S.personswithoutaW-9taxcertificationwhoarenototherwiseexempt.Partiesactingasdisbursementagents,suchasComputershare,mustwithholdandpaytotheIRStheapplicabletaxrateofsuchpaymentsundercertainconditions.Thisiscalled“backupwithholding.”Paymentsthatmaybesubjecttobackupwithholdingincludeinterest,dividends,brokerandbarterexchangetransactions,androyalties.SupplyinguswithyourcorrectTaxpayerIdentificationNumber(TIN),andsigningthisformwillgenerallyallowyoutoreceiveyourpaymentswithoutbeingsubjecttobackupwithholding.FailuretosupplyyourTIN,orsupplyinguswithanincorrectTIN,couldresultina$50.00penaltybeingassessedbytheIRS.ReceiptofacompletedFormW-9willdiscontinuebackupwithholdingunlessotherwiserequired.

Backup Withholding

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Taxpayer IdentificationSocial Security Number (SSN) - If you are completing this on behalf of one of these parties, include the appropriate Social Security Number, as indicated below.1. Individual(TheIndividual)2. Twoormoreindividuals(jointaccount)(Theactualowner,orifcombinedfunds,the

firstindividualontheaccount)3. Custodian account of a minor (Uniform Gift to Minors Act or Uniform Transfers to

Minors Act) (The minor)4. a.Theusualrevocablesavingstrust(Grantorisalsotrustee)

(The grantor-trustee) b.So-calledtrustaccountthatisnotalegalorvalidtrustunderstatelaw

(Theactualowner)5. Soleproprietorship(Theowner)6. GrantortrustfilingunderOptionalForm1099FilingMethod1(Thegrantor)

Employer Identification Number - If you are completing this on behalf of one of these entities, include the appropriate Employer Identification Number, as indicated below.7. Disregardedentitynotownedbyanindividual(Theowner)8. Avalidtrust,estate,orpensiontrust(Legalentity)9. CorporationorLLCelectingcorporatestatusonForm8832orForm2553

(The corporation)10. Association, club, religious, charitable, educational or other tax exempt organization

(The organization)11. Partnership or multi-member LLC (The partnership)12. A broker or registered nominee (The broker or nominee)13. AccountwiththeDepartmentofAgricultureinthenameofapublicentity

(The public entity)14. GrantortrustfilingundertheForm1041FilingMethodortheOptionalForm1099Filing

Method 2 (The trust)

Limited Liability Company or Other ClassificationIfyouareaLimitedLiabilityCompanyorOtherentity,completeanIRSFormW-9foundontheIRSwebsitewww.irs.gov. Be sure to include the information required in the IRS instructions for a Limited Liability Company (LLC)orforOtherentitiesonpage2.Returnthecompletedformtotheaddressbelow.

Exempt Payee CodeGenerally,individuals(includingsoleproprietors)arenotexemptfrombackupwithholding.Corporationsareexemptfrombackupwithholdingforcertainpayments,suchasinterestanddividends.Corporationsarenotexemptfrombackupwithholdingforpaymentsmadeinsettlementofpaymentcardorthirdpartynetworktransactions.Note:ifyouareexemptfrombackupwithholding,youshouldstillcompletethisformtoavoidpossibleerroneousbackupwithholding.1. An organization exempt from tax under section 501(a), any IRA, or a custodial account

under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)2. The United States or any of its agencies or instrumentalities3. A state, the District of Columbia, a possession of the United States, or any of their

politicalsubdivisionsorinstrumentalities4. Aforeigngovernmentoranyofitspoliticalsubdivisionsorinstrumentalities5. A corporation6. A dealer in securities or commodities required to register in the United States, the

District of Columbia, or a possession of the United States7. AfuturescommissionmerchantregisteredwiththeCommodityFuturesTrading

Commission8. Arealestateinvestmenttrust9. AnentityregisteredatalltimesduringthetaxyearundertheInvestmentCompanyAct

of 194010. A common trust fund operated by a bank under section 584(a)11. A financial institution12. Amiddlemanknownintheinvestmentcommunityasanomineeorcustodian13. A trust exempt from tax under section 664 or described in section 4947

ThefollowingcodesidentifypayeesthatareexemptfromreportingunderFATCA.Thesecodes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form foranaccountyouholdintheUnitedStates,youmayleavethisfieldblank.A. Anorganizationexemptfromtaxundersection501(a)oranyindividualretirementplan

as defined in section 7701(a)(37)B. The United States or any of its agencies or instrumentalitiesC. A state, the District of Columbia, a possession of the United States, or any of their

politicalsubdivisionsorinstrumentalitiesD. Acorporationthestockofwhichisregularlytradedononeormoreestablished

securities markets, as described in Reg. section 1.1472-1(c)(1)(i)E. A corporation that is a member of the same expanded affiliated group as a corporation

described in Reg. section 1.1472-1(c)(1)(i)F. Adealerinsecurities,commodities,orderivativefinancialinstruments(including

notionalprincipalcontracts,futures,forwards,andoptions)thatisregisteredunderthelawsoftheUnitedStatesoranystate

G. ArealestateinvestmenttrustH. Aregulatedinvestmentcompanyasdefinedinsection851oranentityregisteredatall

timesduringthetaxyearundertheInvestmentCompanyActof1940I. A common trust fund as defined in section 584(a)J. A bank as defined in section 581K. A brokerL. A trust exempt from tax under section 664 or described in section 4947(a)(1)M. A tax exempt trust under a section 403(b) plan or section 457(g) plan

Exemption from FATCA Reporting

Definition of a U.S. Person. Forfederaltaxpurposes,youareconsideredaU.S.personifyouare: •AnindividualwhoisaU.S.citizenorU.S.residentalien, •Apartnership,corporation,company,orassociationcreatedororganizedintheUnitedStatesorunderthelawsoftheUnitedStates, •Anestate(otherthanaforeignestate),or •Adomestictrust(asdefinedinRegulationsSection301.7701-7).