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Boxes that apply to you, and see the back of this form for instructions and definitions. Legislative references on this form are to the Income Tax Act. Area I Applicant Last name First name and initials Social insurance number Address Telephone If the transfer is from a deferred profit-sharing plan (DPSP), complete parts A, C, and D below. If the transfer is from a registered pension plan (RPP), complete parts B, C, and D below. Part A Transfer from a DPSP I am an employe.

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