DECLARATION OF MARITAL STATUS by bvo16289

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									                                                                             DECLARATION OF MARITAL STATUS

You must complete this form if you are applying to receive pension benefits from the
Calgary District Pipe Trades Pension Plan (“the Plan”).

     In the province of Alberta, “Spouse” means, in relation to the Plan member:
      The person who is married to and living with the member; or
      The person who is married to the member and who has been separated for less than
         three years from the member; or
      If there is no married Spouse, the person who has been living with the member in a
         marriage-like relationship for the immediately preceding three year period.
     The date of determination is the earlier of (a) the date the member’s pension is to start, (b) the date of the member’s death,
     or (c) the end of the second calendar year following the member’s termination of employment or membership in the Union.




I,                                                         of the City of                                          ,    Province
of                                                , solemnly declare that, as of the date of this
Declaration (please check either A or B):

       A. I have a Spouse in accordance with the definition of Spouse indicated above. My
       Spouse’s name is                                                                         .   My Spouse’s date of
       birth is                                            .
       (If you have checked the box, above, you must check and complete one of the following)
                I have been married to my Spouse since                                                                        ; or
                I have been living in a marriage-like relationship since                                                          .
       B. I have no Spouse in accordance with the definition of Spouse indicated above.

I MAKE THIS DECLARATION for purposes of pension entitlements under the Calgary
District Pipe Trades Pension Plan and for no improper purpose;
AND I MAKE THIS SOLEMN DECLARATION conscientiously believing it to be true, and
knowing that it is of the same force and effect as if made under oath, and by virtue of
the Canada Evidence Act.

I sign this declaration at the City of                                                 , Province of                                  ,

this            day of                             ,                .
                                                                                            (signature of applicant)


Notary Public in the Province of
             or                                                                           (signature of Notary Public)
Commissioner for taking
Oaths for the Province of
                                                                                         (signature of Commissioner)

								
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