REGISTERED TYPE: RRSP LIRA LRSP LRIF RRIF: QUALIFIED NON QUALIFIED
PRIF RLIF RLSP TFSA LIF: FEDERAL LIF OLD LIF NEW LIF
SPOUSAL PLAN: NO YES – IF YES, COMPLETE THE FOLLOWING SPOUSAL INFORMATION:
SPOUSAL INFORMATION
FIRST NAME
& INITIALS SURNAME
SOCIAL INSURANCE NUMBER DATE OF BIRTH
LOCKED-IN INFORMATION – LOCKED-IN CONFIRMATION ATTACHED
LOCKED-IN GOVERNING
FUNDS LEGISLATION
CONTACT
NAME
TELEPHONE FAX
NUMBER NUMBER
AUTHORIZED
SIGNATURE
FUND NAME
FUND CODE
FE
FE FEE*
%
FUND CODE
LL
FUND CODE
DSC
AMOUNT
£ $ £ %
TOTAL
MR. MRS. MISS MS DR.
FIRST NAME
SURNAME AND INITIALS
ADDRESS
CITY PROVINCE
POSTAL CODE EMAIL ADDRESS
HOME BUSINESS
TELEPHONE TELEPHONE – EXT.
SOCIAL INSURANCE NUMBER DATE OF BIRTH
TRANSFER AUTHORIZATION FOR REGISTERED INVESTMENTS (RRSP, LIRA, LRSP, RRIF, LRIF, LIF, RLIF, RLSP, PRIF, TFSA)
This form can be used for transferring the registered plans listed above except (1) RRIF to RRSP transfers, (2) RRIF or RRSP to TFSA transfers, (3) TFSA to RRIF or RRSP transfers, (4) transfers due to death and (5) transfers due to marital breakdowns.
Please note: The data entered on this form may be scanned and stored electronically. Please print neatly in the spaces provided to ensure completeness, accuracy and machine readability.
RELINQUISHING
INSTITUTION NAME
ADDRESS
CITY PROVINCE POSTAL CODE
GROUP PLAN CLIENT ACCOUNT/
NUMBER (if applicable) POLICY NUMBER
TRANSFER (Check one box only):
ALL IN CASH
*
ALL AS IS (IN KIND) ALL ASSETS
*
BUT MIXED IN CASH AND AS IS PARTIAL
*
(in kind), (see list below or on attached list) (as listed below or on attached list)
*
Please refer to statement in bold in Client Authorization section below.
( ) ( )
$
(MANDATORY/REQUIRED BY CRA)
Dynamic Funds
®
is a registered trademark of its owner, used under license, and a division of 1832 Asset Management L.P.
INVESTMENT
INSTRUCTIONS
AS PER THE
DYNAMIC
APPLICATION
FORM
1. CLIENT
IDENTIFICATION
2. RECEIVING
INSTITUTION
INFORMATION
3. CLIENT
DIRECTION TO
RELINQUISHING
INSTITUTION
4. CLIENT
AUTHORIZATION
5. FOR USE BY
RELINQUISHING
INSTITUTION
ONLY
DAY MONTH YEAR
DAY MONTH YEAR
DAY MONTH YEAR
11DWD156_TransferAuthForm_EN_V9_DOP_1013 MOE9024
I hereby request the transfer of my account and its investments as described above.
*
Where I have requested a transfer in cash, I authorize the liquidation of all or part of my investments and agree to pay any applicable fees, charges or adjustments.
SIGNATURE OF
ACCOUNT HOLDER
Irrevocable beneficiary: I consent to the transfer of the account.
SIGNATURE OF
IRREVOCABLE BENEFICIARY (if applicable)
INVESTMENT AMOUNT SYMBOL AND/OR CERTIFICATE NUMBER OR POLICY NUMBER INVESTMENT DESCRIPTION
IN KIND IN CASH
SHARES/UNITS DOLLARS
IN KIND IN CASH
SHARES/UNITS DOLLARS
IN KIND IN CASH
SHARES/UNITS DOLLARS
( )
(MANDATORY)
DAY MONTH YEAR
(MANDATORY)
1832 ASSET MANAGEMENT L.P., AS AGENT FOR THE BANK OF NOVA SCOTIA TRUST COMPANY
Dynamic Funds Tower, 1 Adelaide St. E., Ste. 2900, Toronto, ON M5C 2V9, Tel: 416-363-5621, TOLL FREE 1-866-977-0477, Fax: 416-363-4179
GROUP PLAN CLIENT ACCOUNT/
NUMBER (if applicable) POLICY NUMBER
DEALER ADVISOR DEALER ACCOUNT
NUMBER NUMBER NUMBER
DEALER NAME ADVISOR NAME
BUSINESS FAX
TELEPHONE – EXT. NUMBER
REGISTERED TYPE: RRSP SPOUSAL RRSP LIRA LRSP RRIF SPOUSAL RRIF LRIF LIF RLIF RLSP PRIF TFSA
If a new account is to be opened, please attach a Dynamic application form.
*Front end fee is zero unless otherwise specified.
( )
(MANDATORY)
(MANDATORY)
( )
( )
DAY MONTH YEAR
(MANDATORY)
ORIGINAL – DYNAMIC COPY 1 – INVESTOR COPY 2 – DEALER COPY 3 – RELINQUISHING INSTITUTION
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
