A: RECEIVING INSTITUTION
IA Clarington Investments Inc.
IA CLARINGTON INVESTMENTS INC. as agent for the trustee, INDUSTRIAL ALLIANCE TRUST INC. of the IA Clarington registered plan referred to in
Section B (the “Plan”) agrees to administer all locked-in funds transferred to the Plan from the registered plan referred to in Section C, in accordance with
the provisions of the pension legislation identified in Section C.
No payments or transfers from the Plan shall be permitted except those permitted under the pension legislation identified in Section C and the Income Tax
Act (Canada).
IA CLARINGTON INVESTMENTS INC, as agent for INDUSTRIAL ALLIANCE TRUST INC.
__________________________________________
Carl Mustos, President
B: CLIENT INFORMATION
_______________________________________________________________________________________________________ _______________________________________________________________
Planholder name Client account number
IA Clarington plan type: ❑ LIRA ❑ Locked-in RRSP ❑ LIF ❑ PRIF ❑ LRIF _______________________________________________________________
S.I.N.
C: TRANSFERRING INSTITUTION
_______________________________________________________________________________________________________ _______________________________________________________________
Company name Client account number
_______________________________________________________________________________________________________ _______________________________________________________________
Contact name Phone number
Locked-in Funds governed by Pension Legislation
Plan type: ❑ RPP ❑ LIRA ❑ Locked-in RRSP ❑ LIF ❑ PRIF ❑ LRIF
Applicable pension legislation: ❑ Federal (PBSA)
❑ Provincial – specify:
_____________________________________________________________________________________________________________
Original pension plan name (if available):
___________________________________________________________________________________________________________________________________
Status of account plan holder: ❑ Member/Annuitant ❑ Spouse of member ❑ Former spouse of member
The undersigned certifies that the information given on this form is, to the best of his/her knowledge, correct and complete.
_______________________________________________________________________________________________________ _______________________________________________________________
Name of authorized officer Date
_______________________________________________________________________________________________________
Signature of authorized officer
Locked-In Agreement
IA Clarington Investments Inc. c/o International Financial Data Services (Canada) Limited
30 Adelaide Street East, Suite 1, Toronto, ON M5C 3G9
funds@iaclarington.com
|
www.iaclarington.com
Telephone: 1-800-530-0204 | Fax: 1-866-506-9884
(17-1710) 12/19/17-04
iA CLARINGTON INVESTMENTS
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