FOR USE BY
RELINQUISHING INSTITUTION
Delay Delivery Until
Transfer Authorization for Registered Investments (RRSP, LIRA, LRSP, RRIF)
This form can be used for RRSP to RRSP transfers (except for transfers due to death), RRSP to RRIF
transfers, and RRIF to RRIF transfers.
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.
A:
Client
Identication
B:
Receiving
Institution
Information
Account/Policy Holder Last Name
First Name
Initial(s)
Address City Province Postal Code
( )
Social Insurance Number Home Telphone Number
Business Telephone Number
( )
Dealer Name Dealer Number
Agent Name
Agent Number
Business Telephone Number
( )
Business Fax Number
( )
Dealer Plan Number
Investment Instructions:
Investment Name
Amount ($)
Registered Type:
RRSP
RRIF
Spousal
RRSP
Spousal
RRIF
LRSP
LIRA
C:
Client Direction
to Relinquishing
Institution
Relinquishing Institution Name
Client Account/Policy Number
Address
City
Province
Postal Code
Transfer: (check one box only)
All in cash*
Partial*, as listed below or
attached list
*Please refer to statement in bold in Client authorization section below.
In cash
In cash
Investment Amount
Investment Amount
Certicate Number or Policy Number
Certicate Number or Policy Number
Investment Description
Investment Description
D D M M Y Y Y
Y
D D M M Y Y Y
Y
D:
Client
Authorization
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
Date Date
Irrevocable Beneciary: I consent to the transfer of the account.
Signature of Irrevocable Beneciary (if applicable)
E:
For Use by
Relinquishing
Institution Only
Registered Type:
RRSP LIRA LRSP RRIF: Qualied Non-Qualied
Spousal Plan:
No Yes, if yes:
Last Name
First Name
Initial(s) Social Insurance Number
Locked-In:
No
Yes, if yes locked-in conrmation attached
Locked-In Funds
$
Governing Legislation
Contact Name
Authorized Signature
TelephonePhone
( )
Fax Number
( )
Date (DD-MM-YYYY)
622-03-106E (11/18/2013)
B2B BANK
DEPOSIT OPERATIONS
199 BAY STREET, SUITE 600 PO BOX 279 STN COMMERCE COURT
TORONTO
ONTARIO
M5L 0A2
1.800.263.8349
Receiving Institution Name
Contact Name
Address
Province Postal Code
Client Account/Policy Number
City
Telephone Number
For use by
Mutual Fund
Brokers/Dealers
only
$
$
$
