Transfer-in Authorization Form For Registered & Non ... - SEI

SEI Account Number:
Transfer-in Authorization Form
For Registered & Non-Registered Investments
Instructions:
Complete this Transfer-in Authorization form for liquidating
assets from your Account at another Institution (Bank, Broker,
Investment Firm or Mutual Fund Company) and transferring
the assets to your SEI Investments Canada Company
Account.
It is recommended that you confirm with the previous
Institution to see if additional paperwork is required to liquidate
or transfer funds. This step will help avoid delays in receiving
your transfer. If multiple Accounts and/or Institutions are
involved, a form for each Account or Institution is required.
Forward all completed forms directly to the RELINQUISHING
INSTITUTION:
Copies should be mailed to:
SEI Investments Canada Company
c/o RBC Dexia Investor Services
Shareholder Service Department
P.O. Box 7500, Station A
Toronto, ON M5V 1P9
Receiving Institution Information
SEI Investments Canada Company
Receiving Institution Name
Shareholder Service Department
Contact Name
P.O. Box 7500, Station A
Address
Toronto ON M5V 1P9
City Province Postal Code
1-866-716-2977
Fax Number
Specimen Plan Number
A. Dealer Information (For use by Mutual Fund Brokers/Dealers
only)
OR By Fax: 1-866-716-2977
Investment Advisor/Representative Name
Dealer Code/Rep Code
Client Information
Dealer Firm Name
Mr. Mrs. Miss Ms. Dr. Other
Dealer Telephone Number
Dealer Fax Number
Account Policy Holder Last Name
First Name & Initial
Dealer Account Number
Street Address
City
Social Insurance Number
Telephone Number
Province, Postal Code
Business Telephone Number
Account Type (select one)
Non-Registered
Spousal RRSP
Spousal RRIF
LRSP
LIRA
PRIF
RRSP
RRIF
LRIF
LIF
Tax-Free Savings Account
Note: Please include SEI Account # on transfer form prior to sending to the relinquishing institution.
Form # A9-06/11-E
Continued

Transfer-in Authorization Form For Registered & Non-Registered Investments
Page 2
Client Direction to Relinquishing Institution
For Use By Relinquishing Institution Only
A. Account Type (please check applicable box)
Relinquishing Institution Name
Contact Name
Address
RRSP
LIRA
LRSP
RRIF
Qualified
Non-Qualified
LRIF
LIF
Non-Registered
Tax-Free Savings Account
City Province Postal Code
B. Spousal Plan: No Yes (if yes, complete the following)
Telephone Number
Fax Number
Group Plan Number (if applicable)
Last Name
First Name & Initial
Client Account/Policy Number
Social Insurance Number
All in cash
All in-kind
Locked In: No Yes
Partial in cash (as listed below)
$ (or) %
Investment Amount
% of Investment
Partial in-kind (as listed below)
$
Locked-In Funds
Governing Legislation
Investment Description
Investment Code
Contact Name
$ (or) %
Investment Amount
% of Investment
Telephone Number
Fax Number
Investment Description
Investment Code
Authorized Signature
Date
$ (or) %
Investment Amount
% of Investment
Investment Description
Investment Code
Please attach additional instructions if insufficient space
Signature Guaranteed Stamp
(Required for non-registered investments only)
Client Authorization
I hereby request the transfer of my account as described
above.
*I AUTHORIZE THE LIQUIDATION OF MY INVESTMENTS AS IDENTIFIED IN
4 AND AGREE TO PAY ANY APPLICABLE FEES, CHARGES OR
ADJUSTMENTS.
Signature of Account Holder
Date
Form # A9-06/11-E
End of Form