Transcription of WITHDRAWAL FORM - Computershare
1 WITHDRAWAL FORM Privacy Notice Computershare is committed to protecting your personal information. In the course of providing services to you and our corporate clients, we receive non-public personal information about you from transactions we perform for you, forms you send us, other communications we have with you or your representatives, etc. This information could include your name, address, social insurance number, securities holdings and other financial information. We use this to administer your account, to better serve your and our clients needs and for other lawful purposes relating to our services. Computershare may transfer personal information to other companies in or outside of Canada that provide data processing and storage or other support in order to facilitate the services it provides.
2 We have prepared a Privacy Code to tell you more about our information practices, how your privacy is protected and how to contact our Chief Privacy Officer. It is available at our website, , or by writing us at 100 University Avenue, Toronto, Ontario, M5J 2Y1. 1. CLIENT INFORMATION Last Name First Name and Initials Account Number 2. WITHDRAWAL INFORMATION I hereby authorize the below WITHDRAWAL from my account. WITHDRAWAL Details: TFSA / Non-Registered A. Full WITHDRAWAL C. Monthly WITHDRAWAL * In-Cash (To be completed when total plan balance is in cash position) 1st or 15th In-Kind (To be completed when balance contains securities. Please note any residual cash will be included) B. Partial WITHDRAWAL Full cash balance** In-Cash Specific Amount $ Cash Balance Specific Amount: $ * Only available via EFT In-Kind (please use chart below) ** Could include recent contributions RRSP / Spousal RRSP / RRIF A.
3 Deregistration In-Cash Full Deregistration $ Partial Gross (amount REDUCED by withholding tax) $ Partial Net (amount required AFTER withholding tax is taken off) B. Deregistration In-Kind I have ensured $ is available in my plan to cover the required withholding tax I wish to deregister: Full In-Kind (To be completed when balance contains securities. Please note any residual cash will be included) Partial In-Kind (please use chart below) C. Excess RRIF Payment Excess amount of: $ Partial In-Kind WITHDRAWAL Chart I hereby authorize the below WITHDRAWAL from my account. Number of Securities: Stock Name: Number of Securities: Stock Name: Number of Securities: Stock Name: Delivery Instructions Mail Pick Up EFT (Electronic Funds Transfer) 3. CLIENT AUTHORIZATION I agree to indemnify Computershare Trust Company of Canada for all taxes (if applicable), assessments and other charges levied or imposed by any authority relating to my plan.
4 Client s Signature Year Month Day Email: Deliver form to: Computershare Trust Company of Canada Attn: Private Capital Solutions 8th Floor, 100 University Ave. Toronto, ON, M5J 2Y1
