Required Information for a Pension Valuation

 Nom du conjoint:
Date de naissance du conjoint:
Required Information for a Pension Valuation
______________________________
Name of participant:
jj/ ______ mm/ ______ aa/ _________
Date of birth of participant:
______________________________________________________
mm/ ______ dd/ ______ yy/ _________
Si votre conjoint a une pension à faire évaluer, nous autorisez-vous à préparer l’évaluation si une telle demande
est faite?
Namenous
of employer:
Date of mariage:
Oui ______
Non ______
______________________________________________________
du conjoint:
NameNom
of pension
plan:
mm/ ______ dd/ ______ yy/ _________
Date deDate
naissance
du conjoint:
of valuation/separation:
______________________________________________________
mm/ ______ dd/ ______ yy/ _________
mm/ ______
aa/ _________
Circle______________________________
the applicable employment status at the time of jj/ ______
A statement
of pension
entitlements that includes :
separation and, if not active, indicate the effective date of
- Date of employment and of enrolment to the pension plan
that status:
- Pensionable
service
at the date
of marriage
(if any)
Si votre conjoint a une pension à faire évaluer, nous autorisez-vous
à préparer
l’évaluation
si une
telle demande
- Pensionable service at the date of valuation
Activenous
– Full
Time
est faite?
- Accumulated contributions in virtue of the pension plan at
the date of valuation
Active – Part Time
Oui ______
Non ______
- Annual pension benefits accrued at the date of valuation
- Particulars of any service « buyback » (if any)
Terminated :
mm/ ______ dd/ ______ yy/ _________
Note: A statement of pension entitlements with all the above
information is generally available from your employer. We can
Retired:
mm/ ______ dd/ ______ yy/ _________
obtain it on your behalf if a signed consent form is provided to
our firm.
On disability
mm/ ______ dd/ ______ yy/ _________
Indicate the current employment status and, if it differs
from the one above, the date corresponding to the change.
Approximate value of other sources of retirement income at
the date of separation :
______________________________________________________
mm/ ______ dd/ ______ yy/ _________
RRSP :
Non-registered Assets :
Name of Spouse:
Date of birth of spouse:
_________________________________________
mm/ ______ dd/ ______ yy/ _________
If your spouse has a pension to be valued, do you authorize us to prepare the valuation if so
requested?
Yes ______
No ______
Please forward to GML