Planned Gift Confirmation Form

A planned gift is a simple but meaningful way to help North York General Hospital provide exceptional care to our community. Please take a moment to complete this confidential form and return it to us.

I/We confirm the following planned gift to North York General Hospital Foundation:

Bequest in my/our will(s)
Beneficiary of a life insurance policy
Beneficiary % of my RRIF/RRSP proceeds

Please enter the $ amount or % of residue you plan to leave in your bequest

Please enter the $ amount you plan to leave in your life insurance policy

Please enter the % of your RRIF/RRSP you plan to leave

The above planned gift(s) are in honour/memory of

First

Last

Heritage Circle

North York General Hospital Foundation welcomes you as a member of the Heritage Circle. The Heritage Circle recognizes donors of future bequests and other types of planned gifts, as well as promotes philanthropy within our shared community. As a member of the Heritage Circle, you can choose to become an active participant in North York General Hospital's legacy. Members will be invited to an annual event and, those who confirm a legacy commitment of $10,000+ will be acknowledged by having their names listed on the Inspiration Gallery Donor Wall, within the Heritage Circle Category, located on the first floor of our hospital. You will be part of a special group of individuals who are committed to helping our hospital make a world of difference in your own backyard for generations to come. The amount and purpose of your gift are strictly confidential and will not be disclosed publicly, unless otherwise indicated by you.

Please select all that apply

I/We accept the Foundation's invitation to be a member of the Heritage Circle
I/We wish to accept membership, but remain anonymous
I/We wish to be listed on the Inspiration Gallery

Please list my/our name as:

First

Last

Please provide the following information

First

Last

Name of spouse (if applicable)

Address

Address Line 1

City

State / Province / Region

Postal Code

Layout

Date of Birth

Email Address

Phone Number

Spouse Date of Birth (if applicable)

Submission Date

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Planned Gift Confirmation Form

Heritage Circle

Please provide the following information