Alberta Unlocking 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 receive from income and benefits combined in the next consecutive 12 months* This field is required. Albert Low Income Unlock
Please Select
Please Select
Under $25,000
Under $43,700
Over $46,000
5
Are you or your spouse facing foreclosure on a primary residence with a demand letter?* This field is required. Alberta foreclosure Unlock
Please Select
Please Select
Yes
No
6
Are you facing eviction from your residential rental unit to to unpaid rent?* This field is required. Alberta Rental Eviction Unlock
Please Select
Please Select
Yes
No
7
Do you require funds to pay rent and deposit on a new residential tenancy?* This field is required. Alberta New Tenancy Unlock
Please Select
Please Select
Yes
No
8
Do you, your spouse or your dependents require funds to pay medical costs?* This field is required. Alberta Medical Expense Unlock
Please Select
Please Select
Yes
No
9
Have you permanently departed Canada for at least 2 years AND acquired tax exempt status from Canada Revenue Agency?* This field is required. Alberta Departed Canada Unlock
Please Select
Please Select
Yes
No
10
Has an Alberta physician given you an estimated time to survive due to illness/disease?* This field is required. Alberta Short Life Expectancy Unlock
Please Select
Please Select
Yes, I have a shortened life expectancy
No, I have no shortened life expectancy, officially
11
Is your locked-in pension plan valued at $13,320 or less with a statement to verify?* This field is required.Alberta Small Amount Unlock
Please Select
Please Select
Yes
No
12
Are you age 50 or more? You MUST FIRST convert LIRA to a LIF* This field is required. Alberta One Time 50-Years-Plus Unlock
Please Select
Please Select
Yes, I am currently age 50 or more
No, I am currently under age 50
13
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 etransfer - 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.* This field is required. Confirmation
Please Select
Please Select
Yes, I agree to pay after submitting this form
No, I do not agree
Should be Empty: