TFSA Transfer Form - Home Trust

1 You can use this form to record a direct Transfer . Please print, and check the boxes that apply to Savings Account Direct Transfer FormSection I -Name of TFSA issuerAddressPart B - Description of amount to be transferredSection III - Transferor We have transferred $ from the TFSA identi ed in Part A of Section I to the transferee named in Part C of Section II - TransfereeWe agree to the above request for a direct Transfer of property. When we receive the property, we will credit it to the applicant or member under the plan or fund identi ed in Part C of Section I.

2 If the plan or fund is a TFSA that conforms to a specimen plan or fund, it will conform with the specimen identi ed as:DateApplicant's signatureName of TFSA issuerAddressSpecimen planWe will check the plan in Part C of Section l, and add or correct information as A - Transfer from a TFSAS ocial insurance numberAddressLast name First name and initialsTelephoneIndividual plannumber, and nameTransferee's nameAuthorized person's signatureDateDateHOME Trust COMPANYP lease Transfer in CASH all of the property (approximately) $Please Transfer in CASH part of the property in the amount of $I am the applicant under the Tax-Free Saving's Account (TFSA).

3 145 King Street West Suite 2300, Toronto, Ontario M5H 1J8 Agent Account NumberAgent NamePart C - Identifying the TFSA the funds are being transferred toPlease Transfer the above-mentioned TFSA property to my plannumber, and namePosition or o ce I certify that the information given on this form is correct and 's name Account HolderTFSA05710017 DEP TFSATRANS 12-2012