TRANSFER AUTHORIZATION FOR REGISTERED AND NONREGISTERED INVESTMENTS
Head Office
One Westmount Road North
P.O. Box 1603 Stn. Waterloo, Waterloo Ontario N2J 4C7
TF 1.800.668.4095 T 519.886. 4734 Fax 519.883. 740 4
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
114(2018/03/12) Page 1 of 2
1. Client Identification
Name of Policy Owner(s)
Address
(Street, City, Province, Postal Code)
Social Insurance Number Telephone Number
2. Relinquishing Institution
Name of Relinquishing Institution Fax No.
Address
(Street, City, Province, Postal Code) Client Policy Number
I hereby request the transfer, IN CASH, from the above noted account/contract to Equitable Life:
All of the value OR A partial withdrawal as specified below:
Note: Full withdrawals of RIF/LIF plans require the payment of the Required Minimum prior to transfer.
Registration Type:
Non-Registered TFSA RRSP LIRA LIF RRIF
PRIF LRIF RLIF RLSP LRSP RPP
Spousal Plan?
Yes No - If Yes, provide the following details about the spousal contributor.
First name
Last name Social Insurance Number
Locked-in pension funds?
Yes No - If Yes, provide the following details.
Legislation Plan name
Note to relinquishing institution:
• Where required by applicable legislation, please provide the investment gain/loss to date of transfer for the current calendar year.
• If the funds are being transferred from a RIF, please confirm if the funds are from a qualifying RIF upon transfer.
Investment Name
Fund Code
(if applicable)
% / $ Amount
TRANSFER AUTHORIZATION FOR REGISTERED AND NONREGISTERED INVESTMENTS
THE EQUITABLE LIFE INSURANCE COMPANY OF CANADA
114(2018/03/12) Page 2 of 2
3. Receiving Institution Information
The Equitable Life Insurance Company of Canada 1.800.668.4095 519.883.7404
Receiving Institution Business Telephone Number Fax Number
One Westmount Road North • PO Box 1603 Stn Waterloo • Waterloo ON N2J 4C7
Address (Street, City, Province, Postal Code)
Advisor Name Advisor code Advisor telephone number
Please deposit the assets transferred into the following policy:
Policy/Application number
Product type:
Segregated Funds Guaranteed Interest Account Payout Annuity
Registration Type:
Non-Registered TFSA RRSP Spousal RRSP RRIF Spousal RRIF
Locked-In Retirement Account (LIRA, RLSP, LRSP) Life Income Fund (LIF, PRIF, LRIF, RLIF)
Investment Instructions:
Deposit according to the existing investment instructions on file, OR Deposit to the investment instructions specified below:
Locked-In Funds Confirmation:
The Equitable Life Insurance Company of Canada agrees to administer any locked-in funds transferred under this transfer authorization according
to the governing pension legislation indicated in section 2.
Authorized Signature Date
Investment Name
Fund Code
(if applicable)
% / $ Amount
4. Client Authorization
I authorize the withdrawal of all or part of my investment as indicated above and agree to the value being reduced by any applicable fees, taxes,
charges or adjustments.
Signature of Policy Owner Date
Signature of Joint Policy Owner (if applicable) Date
Signature of Irrevocable Beneficiary (if applicable) Date
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.
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