Application for a Statement of Benefits in the Course of Family Mediation

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 couples who:

• are married or in a civil union
• stopped living together
• have begun a family mediation process for the purposes of divorce, separation from bed and board or annulment of marriage, or for the dissolution or annulment of a civil union
• would like a valuation 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.