Application for an Optional Statement of Benefits

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 not 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
• have not taken steps with a notary for a dissolution of a civil union, in the case of spouses in a civil union
• would like a valuation of the benefits on the date on which they stopped living together.

It is optional since the administrator is not required to provide the Statement.

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