CIBC INVESTOR SERVICES INC.
7439 ISI INT-2021/02
Page 1 of 2
Retirement Savings Plan(RRSP) Withdrawal Request
The CIBC logo is a trademark of CIBC, used under license.
Client Information (must be fully completed)
Client's Surname Client's First Name
RRSP Account Number
1. What type of withdrawal would you like to do? (please choose one)
Home Buyers’ Withdrawal (HBP), (please include the Revenue Canada Form Number T1036); or
Lifelong Learning Plan (LLP) Withdrawal, (please include the Revenue Canada Form Number RC96)
Taxable Withdrawal Full (account to be closed); or
Taxable Withdrawal Partial – If gross or net are not indicated, the default will be gross
Gross or Net (after withholding taxes and fees)
Note: No taxes are required to be withheld for HBP or LLP withdrawals.
2. How would you like to receive your payment? (please choose one)
Cash (Canadian Dollars)
Cash (USD) (only applicable for payments to ISI Accounts)
In-Kind
Mixture of In Cash and In-Kind
Definition of “in kind”: The transfer/withdrawal of actual investments; securities are transferred/withdrawn in their present form (as is). If securities are to be withdrawn “in-
kind” or a “Mixture of In-Cash and In-kind” applicable fees will apply
Example: Stock Certificates (100 shares of CIBC Common-CM) or Mutual Funds Units (100 units of CIBC US Equity Fund).
Note: If the currency of payment is not specified, the amount will be paid in Canadian dollars. If the payment currency selected is a currency other than Canadian, your payment will be
calculated based on the applicable exchange rate on the business day prior to when your payment is processed.
3. Where would you like the withdrawal sent? (please choose one)
Transfer the requested amount to my bank account
Transfer the requested amount to my CIBC Investor Services Inc. Non-Registered Account
Acknowledgement (please read carefully and sign below)
I acknowledge that:
a) I cannot revoke (cancel) this withdrawal request later on;
b) I have funds (cash) available to process this withdrawal in the specified Currency of Payment (including any required withholding taxes and
fees for taxable withdrawals);
c) Withholding tax if applicable, is calculated and applied in Canadian dollars, and I am responsible for determining any other tax
consequences;
d) A T4RSP or NR4 (and a Relevé 2 if I have indicated that I reside in Quebec) will be issued for the year a taxable or LLP withdrawal occurs;
e) For all payments/transfers in a currency other than Canadian dollars, all tax reporting will show the Canadian dollar equivalent of the
payment and calculated using the exchange rate as of the close of the business day immediately prior to your payment date. The payment
will be made using the foreign dollars in your ISI account, and no cash conversion will take place;
f) All withdrawals (other than HBP & LLP withdrawals) are subject to a fee;
g) Quebec only: You have asked that this form and all related documents be in English only.
Vous avez exigé que la présente formule et tous les documents qui s’y rattachent soient rédigés en anglais.
Date (Month day, year) Name
X
Signature (sign within box)
