TD Bank Group
Designation of Beneficiary
Branch Stamp
To: The Canada Trust Company, Trustee
("we", "our", and "us")
From: Plan Number:
(Planholder- "you", "your" and "yours") (the "Plan")
Type of Plan: RSP Locked-in? Yes
(attach copy of statement)
You revoke any prior designation of beneficiary made by you in respect of the Plan. If permitted by applicable law,
you designate the beneficiaries named below to receive the proceeds of the Plan when you die in accordance with the
provisions of this designation and the Plan:
Names of Beneficiaries Relationship Share
(as % or fraction)
This beneficiary designation may be overridden:
by your subsequent written beneficiary designation or revocation received by and in a form reasonably acceptable
to us;
by notice to us of a valid will or codicil that specifically designates a beneficiary for the Plan which postdates the
latest beneficiary designation filed with us; or
in whole or in part if your Plan is locked-in, by payment of benefits on your death to your spouse, if any, pursuant
to applicable pension laws.
When you die, we will, upon receipt of all documentation which we may reasonably require, distribute the net
proceeds of the Plan in accordance with the operative beneficiary designation. If any designated beneficiary
predeceases you and no alternative or replacement beneficiary is designated, the applicable amount will be paid to
your legal personal representative for distribution to your estate. On making any such payment, we shall be released
from all further obligations under the Plan.
Date Signature of Planholder
Copy 1 - Branch Copy / Copy 2 - Customer Copy
595524 (0520)