ABC Company	Policy number: 22222222
Registered Retirement Savings Plan

Specify a reason for termination Termination for: Jane Bradley

Please check one:

Termination of employment Retirement Termination of membership

If termination is due to death... Press 'Cancel' and complete a Notice of Death form (GP0770E) instead. Return the completed form to Manulife Financial with the appropriate proof of death.

Termination date:

The policies affected by this request are listed below. You may uncheck any policies that should not be included in this request. Please provide the last contribution details for each policy the member is leaving.

Policy(s) Member number Last contribution details RRSP Policy 22222222 66152 Provide the period ending date: