Transcription of Transfer Authorization for Registered and Non-Registered ...
1 Transfer Authorization for Registered and Non-Registered Investments(RSP, LIRA, LRSP, RIF, LRIF, LIF, RLIF, RLSP, PRIF, TFSA, Non-Registered )PLEASE NOTE:The data entered on this form may be scanned and stored electronically. Please print neatly in the spaces provided to ensure completeness,accuracy and machine CLIENT IDENTIFICATIONA ccount/Policy Holder Last Name or Non-Personal NameFirst NameInitialAddress (Street, Apt., City, Province, Postal Code) Social Insurance Number Date of BirthHome Telephone NumberB. RECEIVING INSTITUTION INFORMATIOND ealer Number Advisor CodeDealer NameAdvisor NameDealer Cross Reference Telephone NumberBusiness Fax NumberACCOUNT TYPE:C.
2 CLIENT DIRECTION TO RELINQUISHING INSTITUTIONMake cheque payable to Fidelity Investments Canada ULCR elinquishing Institution NameClient Account/Policy NumberGroup Plan Number (if applicable)Address (Street, City, Province, Postal Code) Transfer :(check one box only)All in cash*All as is (in Kind)All assets*, but mixed in Cash and as is (in Kind), see list below or attached listPartial* aslisted below or on attached list*Please refer to statement in bold in Client Authorization section Amount Symbol and/or Certificate Number or Policy NumberInvestment Description Delay Delivery Until Investment Amount Symbol and/or Certificate Number or Policy NumberInvestment Description Delay Delivery Until D.
3 CLIENT AUTHORIZATIONI hereby request the Transfer of my account and its investments as described I HAVE REQUESTED A Transfer IN CASH, I AUTHORIZE THE LIQUIDATION OF ALL OR PART OF MY INVESTMENTS AND AGREE TO PAY ANY APPLICABLE FEES, CHARGES OR FOR USE BY RELINQUISHING INSTITUTION ONLYLast NameFirst NameInitialSocial Insurance NumberLocked In:Locked-In amountTotal AmountGoverning LegislationContact NameTelephone Number Fax NumberAuthorized SignatureDateRRSPRRIFS pousal RRSPS pousal RRIFLIRALRIFRLIFRLSPPRIFTFSANon-Register edLRSPLIFA ccount Type: RRSPLIRALRSPRLSPRRIF:QualifiedNon QualifiedLRIFLIFPRIFRLIFTFSANon-Register edINVESTMENT INSTRUCTIONS:COMMISSION REBATE:# dnuFemaN dnuF% egrahC selaS# dnuFemaN dnuFClient Account D D/M M/YYYYD D/M M/YYYYFOR USE BY RELINQUISHING INSTITUTIONNoYes (Attach Locked-In confirmation)$D D/M M/YYYY DateD D/M M/Y Y Y YDateD D/M M/Y Y Y YDateD D/M M/Y Y Y 23864 01/18 This form can be used for RSP to RSP transfers (except for transfers due to death), RSP to RIF transfers, RIF to RIF transfers, TFSA and Non-Registered Plan.
4 YNoes if yes, complete the following informationD D/M M/YYYYI ndicate Amount $%Indicate Amount $%In CashIn KindIn CashIn Kind$%$%Fidelity Investments Canada ULC(agent for Computershare Trust Company of Canada)483 Bay Street, Suite 300 Toronto, Ontario M5G 2N7 Client Services: 1 800 263-4077 Fax: 1 800 387-8092 Irrevocable Beneficiary: I consent to the Transfer of the of Irrevocable Beneficiary (if applicable) Signature ofAccount Holder Signature of Joint AccountHolder (if applicable)
