REQUEST FOR DOCUMENTS TO TRANSFER TO A
MANITOBA PRESCRIBED REGISTERED RETIREMENT INCOME FUND CONTRACT (PRIF)
Mackenzie Investments, 180 Queen Street West, Toronto, Ontario M5V 3K1
service@mackenzieinvestments.com
1= Mr.
2= Mrs.
3= Miss
4= Ms.
5= Dr.
2. TRANSFER INSTRUCTIONS. PLEASE COMPLETE
YOU ARE LIMITED TO A ONE-TIME TRANSFER OF UP TO 50% OF THE BALANCE IN ONE OR MORE OF YOUR LIFS OR LRIFS TO A PRIF.
LIF or LRIF Plan Number Funds/Portfolio to be Transferred Amount Requested to be Transferred
3. DECLARATION. PLEASE COMPLETE
Please send me the necessary documents, which will allow me to apply for a one time Prescribed Transfer from my Mackenzie LIF/LRIF to a
Mackenzie
Prescribed Registered Retirement Income Fund Contract
, as allowed under the Pension Benefits Act of Manitoba.
I declare that:
• I am not living separate and apart from my spouse or common-law partner by reason of a breakdown of marriage.
• The name of my spouse or common-law partner is
• I have not previously made a prescribed transfer from one or more LIFs or LRIFs to a prescribed Registered Retirement Income Fund under
section 21.4 of The
Pension Benefits Act
.
• The above-mentioned plan is not subject to a maintenance order under The Garnishment Act, a preservation order under section 59.3
of The Family Maintenance Act; or a division under the credit splitting provisions under section 31(2) of The Pension Benefits Act.
Dated at
this day of , 20
city/town, province
Signature of Planholder
1. PLANHOLDER INFORMATION. PLEASE PRINT
Last Name
First Name & Initials
Address Apt. No.
Address Postal Code
City Province
Social Insurance Number
Birth Date (DD MMM YYYY)
Home Telephone
Business Telephone
E-mail Address
129751 11/17
