Fillable FSCO Family Law Form 2 IMPORTANT Commission of (Collège Boréal)

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FSCO Family Law Form 2 IMPORTANT Commission of (Collège Boréal)

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Country of origin: CANADA
File type: PDF

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For Plan
Administrator
Use
Effective (2013-01-01)
FSCO (1266E.2)
FSCO Family Law Form 2
Page 1 of 2
Financial Services
Commission
of Ontario
Joint Declaration of Period of Spousal Relationship
FSCO Family Law Form 2
Approved by the Superintendent of Financial Services pursuant to
the Pension Benefits Act, R.S.O. 1990, c. P.8
IMPORTANT
• Read the User Guide and Questions and Answers before completing this form.
• You may want to get legal advice before completing this form.
• You may use this form as a joint declaration of the starting date of your spousal relationship (e.g. if you do not have
a marriage certificate) and/or the separation date (Family Law Valuation Date) of your spousal relationship.
• If you and your spouse/former spouse have chosen to provide two Family Law Values under Appendix A of the
Application for Family Law Value (FSCO Family Law Form 1), you should not complete Part D of this form. [Note:
“Family Law Value” means “imputed value” under the Ontario Pension Benefits Act.]
• Send this form to the pension plan administrator (Plan Administrator) with your Application for Family Law Value
(FSCO Family Law Form 1). DO NOT SEND THIS FORM TO THE FINANCIAL SERVICES COMMISSION OF ONTARIO
(FSCO).
Part A
Pension Plan Information
Name of Pension Plan
Pension Plan Registration Number
Mailing Address of Plan Administrator (Street Number and Name)
Suite/Floor No.
City
Province
Postal Code
© Queen's Printer for Ontario, 2013
PRINT
RESET
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For Plan
Administrator
Use
Effective (2013-01-01)
FSCO (1266E.2)
FSCO Family Law Form 2
Page 2 of 2
Part B
Plan Member and Plan Member’s Spouse/Former Spouse Information
Plan
Member
Last Name
First Name and Initials
Plan Member’s Employee/Pension Plan Identification Number (if known)
Plan Member’s
Spouse
/
Former Spouse
Last Name
First Name and Initials
Part C
Confirmation of the Starting Date of our Spousal Relationship (Married or Common-Law)
We confirm that the starting date of our spousal relationship is:
(
yyyy/mm/dd)
Part D
Confirmation of our Separation Date (Family Law Valuation Date)
We confirm that our separation date (Family Law Valuation Date) is:
(yyyy/mm/dd)
Jointly Declared By:
Plan Member
Signature of Plan Member
Name of Plan Member (printed)
Date (yyyy/mm/dd)
Signature of Witness
Name of Witness (printed)
Date (yyyy/mm/dd)
Witness Contact Information
Mailing Address (Street Number and Name)
Apt./Unit No.
City
Province
Postal Code
Telephone Number (Main)
( )
Spouse/Former Spouse of the Plan Member
Signature of Spouse/Former Spouse of the Plan Member
Name of Spouse/Former Spouse of the Plan Member
(printed)
Date (yyyy/mm/dd)
Signature of Witness
Name of Witness (printed)
Date (yyyy/mm/dd)
Witness Contact Information
Mailing Address (Street Number and Name)
Apt./Unit No.
City
Province
Postal Code
Telephone Number (Main)
( )
© Queen's Printer for Ontario, 2013
PRINT
RESET
SAVE
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FSCO Family Law Form 2 IMPORTANT Commission of (Collge Boral)

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Completed 10 December 2021

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