Ontario Unlock Request Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Your Facebook profile link
Paste your profile link here
4
How much are you currently set to earn from income and benefits combined in the next 12 consecutive months?* This field is required.Ontario Low Income Unlock
Please Select
Please Select
Under $25,000
Under $43,700
Over $46,000
Low Income
5
Are you currently overdue on rent or mortgage?* This field is required.
Please Select
Please Select
Yes, I am overdue on my mortgage and I have a formal demand letter
Yes, I am overdue on my mortgage but I do not yet have a formal demand letter
Yes, I am overdue on my residential rent
No, I am not currently overdue on my rent or mortgage
6
Do you, your spouse or your dependents require funds to cover medical expenses?* This field is required. Ontario Medical Expense Unlock
Please Select
Please Select
Yes
No
Medical
7
Do you require funds to cover new residential rental and deposit? Ontario Rent and Deposit Unlock
Please Select
Please Select
Yes
No
Rent and Deposit
8
Once we provide the form(s) and information required for you to easily unlock your locked in plan (LA, LRIF, LIF or LIRA), you will be required to pay $49.99 + 5% GST = $52.49 CAD by e-transfer - DO YOU AGREE TO PAY IMMEDIATELY UPON RECEIPT OF OUR EMAIL? We will email you within two business hours. No cancellations accepted after submitting this form.
Please Select
Please Select
Yes, I agree to pay after submitting this form
No, I do not agree
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