Application for a Statement of Benefits for Former De Facto Spouses

This form allows a person to request a Statement of Benefits regarding a voluntary retirement savings plan (VRSP) or a supplemental pension plan in the private, municipal or university sectors.

This form concerns former spouses who:

• were recognized de facto spouses
• no longer live together
• would both like to know the total value of the benefits on the date on which they stopped living together.

If needed, consult the table of forms for requesting a Statement of Benefits.