Policy Information
Pursuant to the terms of the Segregated Funds Loan Program Distribution Agreement among B2B Bank
and Industrial Alliance Insurance and Financial Services Inc. dated January 27, 2011 (the “Agreement”),
the undersigned hereby notifies Industrial Alliance Insurance and Financial Services Inc. that the
Agreement and the Confirmation of Assignment / Hypothecation shall no longer apply to the above Policy
Number (the “Policy”), nor the above policy owner, which was assigned or hypothecated, as the case
may be, to the undersigned on the above date.
As the assignment and hypothecation of the Policy to the undersigned has been terminated, the
undersigned no longer has any interest in the Policy.
TO: Industrial Alliance Insurance and Financial Services Inc.
FROM: B2B Bank
Policy Number:
Policy Owner:
Date of Assignment / Hypothecation:
Name:
Title:
Per:
B2B BANK
Dated at Toronto, , 20
Satisfaction Piece and Release
of Hypothec
817-03-214E (11/18/2013)
199 Bay Street, Suite 600 PO Box 279 STN Commerce Court Toronto ON M5L 0A2 Toll free 1.800.263.8349 Fax 1.866.941.7711
