• A withdrawal from one fund and a deposit to another will result in the funds being out of the market for at least one valuation day. Unit
values fluctuate daily and there is a risk of being out of the market during a unit value change.
• The withdrawal transaction could negatively affect the value of the contract’s Death Benefit Guarantee.
• The withdrawal transaction could negatively affect the value of the contract’s Maturity Guarantee.
• A withdrawal may result in a capital gain or a capital loss since it creates a taxable disposition (non-registered contracts only).
• You may be charged deferred sales charges for the withdrawal portion of this transaction.
• Movement between sales charge options must be within the same guarantee class.
• You have the right to change your mind within two business days of either of the date you receive confirmation or five business days after
it is mailed. With written notification, we will refund the lesser of the value of your deposit or the market value on the day we receive your
request. Fees and charges will be refunded.
Name of Policy Owner
Your signature below states you agree with all information and instructions set out above:
Please ensure minimums are met. Minimum age restrictions may apply to deposits.
1388(2020/12/07)
Head Office
One Westmount Road North
P.O. Box 1603 Stn. Waterloo, Waterloo Ontario N2J 4C7
TF 1.800.668.4095 T 519.886.5210 F 519.883.740 4
www.equitable.ca
Funds to be Withdrawn Funds to be Deposited
Fund Code You must check one Fund Code % being allocated
All $
All
$
All
$
All
$
➡
This form is for moving funds between sales charge options within the same contract, based on the following rules:
• Funds in the Deferred Sales Charge Option can only be moved to the No Load Sales Charge Option.
• Funds in the Low Load Option can only be moved to the No Load Sales Charge Option.
• Funds in the No Load, No Load CB or No Load CB5 sales charge options cannot be moved to a different sales charge option.
Date Policy Owner Signature Joint Policy Owner Signature
1. CONTRACT DETAILS - A policy must be in force for at least 90 days before the Change of Sales Charge Option form can be submitted.
2. WITHDRAWAL/DEPOSIT DETAILS
3. TERMS AND CONDITIONS
4. SIGNATURES
First Last
Pivotal Select Policy Number
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
Please note: Equitable Life
®
cannot ensure the privacy and confidentiality of any information sent through the internet because e-mail may be vulnerable to
interception. As a result, Equitable Life is not responsible for any loss or damages you may incur if your information is intercepted and misused. If you would
prefer to submit your information by another means, please contact us at 1.800.668.4095.
PIVOTAL SELECT – CHANGE OF SALES CHARGE OPTION
