FORM 3:  Request for Transfer from Unmatured Defined Contribution Plan
Family Relations Act, section 73

__________________________________________________________________________

         To:     Administrator of pension plan 

         Name of Plan:       _______________________________________________

         Address of Plan:    _______________________________________________

         (please print)      _______________________________________________

_______________________________________________________________________

         From:     Spouse of member (Note:  "spouse"  includes a former spouse.)

         Name:             _______________________________________________

         Address:          _______________________________________________

         Telephone: (home) ________________  (work) __________________

         Social Insurance No.: _______________________________________

__________________________________________________________________________

         In relation to:     Plan member 

         Name of member:     _______________________________________________

         Address:            _______________________________________________

                             _______________________________________________

         Telephone:   (home) __________________  (work) ________________

         Social Insurance or Pension Plan Identity Number: _______________________

         Employer:           _______________________________________________

__________________________________________________________________________

Other required information:  

* Date of marriage ___________________________

* Entitlement Date+ for Spouse: ____________________________

+(Note: This is the date on which the spouse became entitled to an
interest in the member's pension in accordance with s. 56 (1) of the
Family Relations Act (see below).)

* A copy of the separation agreement or court order on which the entitlement date is based++
++(Note: to be attached to or enclosed with this Form.)

__________________________________________________________________________

         Request:  I request that you  

         (a)  transfer my share of the member's  account balance by a transfer that is permitted
              by s. 33 (2) of the Pension Benefits Standards Act, and

         (b)  advise me in writing of the information that you require in order to do this.


         ________________________________________     ________________________
                                  Signed (Spouse)                         Date

         ________________________________________
          Signed (Witness to signature of Spouse)


         Name of Witness:________________________________________________

         Address of Witness:______________________________________________

______________________________________________________________________

Family Relations Act, section 56: 
(1)  Subject to this Part and Part 6, each spouse is entitled to an interest in each family asset on or after March 31, 1979, when  
(a) a separation agreement,
(b) a declaratory judgment under section 57, 
(c) an order for dissolution of marriage or judicial separation, or
(d) an order declaring the marriage null and void 
respecting the marriage  is first made.