FORM 3.2 FORMULE 3.2 P-5.1 Pension Benefits Act …

1 Benefits Act91-195 FORM OF TRANSFER OFLOCKED-IN RETIREMENT FUNDS(General Regulation - Pension Benefits Act, ( ) and ( ))PART I Transferee Information (To be completed by the transferee)_____Financial Institution (Trustee for LIRA, LIF or Annuity) or Pension PlanAdministrator_____AddressCityProvinc ePostal Code(_____)_____Telephone_____ (_____)_____Broker named in LIRA or LIFT elephone(if any)_____AddressCityProvincePostal CodeType of fund to which assets are being transferred: LIRA ___ LIF ___ Annuity ___ Pension Plan _____CCRA Registration Registration Number_____Name of Retirement Savings Arrangement or Pension PlanOwner Information (To be completed by the transferee)_____ _____NameSocial Insurance Number_____AddressCityProvincePostal Code_____(_____)_____Date of BirthTelephone_____Owner s Account Number with TransfereeTransferee Agreement (To be completed by the transferee)As the financial institution or Pension plan to receive theassets as trustee, the assets shall only be accepted if theassets are transferred in compliance with the Pension Bene- FORMULE DU TRANSFERT DES FONDS DE RETRAITE IMMOBILIS (R glement g n ral - Loi sur les prestations de Pension , art.)

2 21( ) et ( ))PARTIE I Renseignements sur le cessionnaire (Doit tre rempli par le ces-sionnaire)_____Institution financi re (fiduciaire pour un CRI, FRV ou une rente) ou admi-nistrateur d un r gime de Pension _____AdresseVilleProvinceCode Postal (_____)_____T l phone_____ (_____)_____Nom du courtier du CRI ou FRV T l phone(le cas ch ant)_____AdresseVilleProvinceCode Postal Type de fonds auquel les l ments d actif sont transf r s :CRI ____ FRV ____ Rente ____ R gime de Pension _____Num ro d enregistrement Num ro d enregistrementdu ADRCdu _____Nom de l arrangement d pargne-retraite ou du r gime de Pension Renseignements sur le propri taire (Doit tre rempli par le ces-sionnaire)_____ _____NomNum ro d assurance sociale_____AdresseVilleProvinceCode Postal _____(_____)_____Date de naissanceT l phone_____Num ro de compte du propri taire aupr s du cessionnaireEntente du cessionnaire (Doit tre rempli par le cessionnaire)En tant qu institution financi re ou r gime de Pension quire oit les l ments d actif titre de fiduciaire, les l mentsd actif doivent seulement tre accept s s ils sont transf r s13091-195 Loi sur les prestations de Act and regulations.

3 The assets shall be transferred intothe registered account referred to in Part I. It is understoodthat if the assets are not transferred in compliance with theAct and regulations, the transfer is void and all assets trans-ferred shall be returned to the transferor. The trustee under-takes to comply with the Act and the regulations while theassets remain under its certify that the information given on this form is correctand complete and that I am authorized to act on behalf ofthe financial institution or Pension _____Name (Print)Position or Office_____ _____Authorized SignatureDateOwner Transfer Information (To be completed by the Owner)As the owner of the assets to be transferred, I agree to thetransfer and understand that the assets must be transferred incompliance with the Pension Benefits Act and regulations.

4 Ishall only request that the assets be transferred in compli-ance with the Act and regulations and I understand that ifthe assets are not transferred in compliance with the Act andthe regulations, the transfer is void. _____ dollars and _____ cents Amount of Transfer (in words)$_____Amount of Transfer (numerical)- OR - Total Remaining Balance I request that the assets be transferred as checked 5, to theabove mentionedLIRA _____ LIF _____ Annuity _____ PensionPlan _____ (initial applicable fund type)I certify that the information given on this form is correctand complete and I agree to comply with the terms of thetransfer as required by the Pension Benefits Act and the _____Owner s SignatureDateconform ment la Loi sur les prestations de Pension et auxr glements.

5 Les l ments d actif doivent tre transf r sdans le compte enregistr vis la Partie I. Il est entenduque si les l ments d actif ne sont pas transf r s conform -ment la Loi et aux r glements, le transfert est nul et les l ments d actif transf r s doivent tre retourn s l auteurdu transfert. Le fiduciaire s engage se conformer la Loiet aux r glements tant que les l ments d actif demeurent enfiducie. Je certifie que les renseignements donn s la pr sente for-mule sont exacts et complets et que je suis autoris agir aunom de l institution financi re ou du r gime de Pension . _____ _____Nom (inscrire en Poste ou fonctionlettres moul es)_____ _____Signature autoris eDateRenseignements sur le transfert du propri taire (Doit tre rem-pli par le propri taire)En tant que propri taire des l ments d actif transf rer,j accepte le transfert et comprend que les l ments d actifdoivent tre transf r s conform ment la Loi sur les presta-tions de Pension et aux r glements.

6 Je dois seulementdemander ce que les l ments d actif soient transf r sconform ment la Loi et aux r glements et je comprendsque si les l ments d actif ne sont pas transf r s conform -ment la Loi et aux r glements, le transfert est nul. _____dollars et _____ centsMontant du transfert (en lettres)_____$Montant du transfert (num rique)- OU - valeur r siduelle totaleJe demande que les l ments d actif soient transf r s, telque coch 5, au type de fonds pr cit : CRI _____ FRV _____ Rente _____ R gime depension _____ (parapher le type de fonds applicable)Je certifie que les renseignements donn s la pr sente for-mule sont exacts et complets et j accepte de me conformeraux modalit s du transfert tel qu exig par la Loi sur lesprestations de Pension et les r _____Signature du propri Benefits Act91-195 NOTE: (a)This form is to be completed in triplicate.

7 (b)After Part I is completed, forward this form, in tripli-cate, to the Transferor for completion of Part II (To be completed by the transferor)Transferor Information and Agreement _____Pension Plan Administrator or Financial Institution_____ Registration NumberCCRA Registration NumberThe assets for the transfer originate from:____a Pension plan that complies with the Act and regu-lations and from which the assets are being trans-ferred under section 36 of the Act____a Pension plan that complies with legislation similarto the Act in a designated jurisdiction and fromwhich the assets are being transferred under a provi-sion similar to section 36 of the Act____another retirement savings arrangement that com-plies with the Act and regulations (LIF or LIRA)____a life or deferred life annuity under a contract thatcomplies with the Act and regulations____ the fund of a Pension plan that is sponsored by theProvince _____ dollars and _____ cents Amount of Transfer (in words)$_____Amount of Transfer (numerical)

8 - OR - Total Remaining Balance Was the commuted value of the amount for transfer deter-mined on transfer in a manner that differentiated on thebasis of the sex of the owner?Yes ____ No ____REMARQUE : a)La pr sente FORMULE doit tre remplie en trois exemplai-res. b)Lorsque la Partie I est remplie, remettre la pr sente for-mule en trois exemplaires l auteur du transfert afin qu ilremplisse la Partie II. PARTIE II (Doit tre rempli par l auteur du transfert)Renseignements sur l auteur du transfert et entente _____Administrateur du r gime de Pension ou institution financi re_____ _____Num ro d enregistrement Num ro d enregistrement du ADRC Les l ments d actif pour le transfert proviennent :____d un r gime de Pension qui se conforme la Loi etaux r glements et duquel les l ments d actif sonttransf r s en vertu de l article 36 de la Loi____d un r gime de Pension qui se conforme une l gis-lation semblable la Loi dans une autorit l gisla-tive et duquel les l ments d actif sont transf r s envertu d une disposition semblable l article 36 de laLoi____d un autre arrangement d pargne-retraite qui seconforme la Loi et aux r glements (un FRV ouCRI)____d une rente viag re ou d une rente viag re diff r een vertu d un contrat qui se conforme la Loi et auxr glements ____d un fonds d un r gime de Pension qui est parrain par la province _____dollars et _____ centsMontant du transfert (en lettres)_____$Montant du transfert (num rique)

9 - OU - valeur r siduelle totaleEst-ce que la valeur de rachat du montant transf rer a t d termin e sur transfert d une mani re diff rente e t gardau sexe du propri taire? Oui ____ Non ____13291-195 Loi sur les prestations de certify that I have authenticated the New Brunswick Reg-istration Number given in Part I, that the information in PartII is correct and complete and, with respect to this transfer, Ihave complied with the provisions of the Pension BenefitsAct and the regulations. It is understood that if the assets arenot transferred in compliance with the Act and the regula-tions, the transfer is _____Name (Print)Position or Office_____ _____Authorized SignatureDateNOTE:This form shall be forwarded in triplicate to the transfereewith the transferred assets for completion of Part III (To be completed by the transferee)Receipt by TransfereeWe have received $_____ in compliance withthe Pension Benefits Act and have noted that the commuted value of the transfer was___/ was not ___ differentiated on the basis of the sex of certify that this form was completed in compliance withthe Pension Benefits Act and _____Name (Print)Position or Office_____ _____Authorized SignatureDateNOTE.

10 The transferee shall retain one copy of the completed formuntil ninety-three years after the owner s date of birth. Thesecond copy of the completed form shall be returned to thetransferor, who shall retain the copy until ninety-three yearsafter the owner s date of birth. The third copy of the com-pleted form shall be given to the ; 2003-87Je certifie avoir authentifi le num ro d enregistrement duNouveau-Brunswick donn la Partie I, que les renseigne-ments donn s la Partie II sont exacts et complets et, en cequi a trait au pr sent transfert, que je me suis conform auxdispositions de la Loi sur les prestations de Pension et desr glements. Il est entendu que si les l ments d actif ne sontpas transf r s conform ment Loi et aux r glements, letransfert est nul.