Form 5 - Waiver Of 60% Joint Pension (Page 3 of 4) in pdf

Form 5 - Waiver Of 60% Joint Pension Page 3

FORM 5

WAIVER OF 60% JOINT PENSION ENTITLEMENT

FOR PENSION PLAN OR LOCKED-IN RETIREMENT ACCOUNT

The Pension Benefits Act, Sections 23, Pension Benefits Regulation, Section 3.35,

Section 10.2 of Division 1, and Section 10.22 of Division 2 of Part 10

I,_________________________________________________, am the spouse or common-law partner

(as described above) of ______________________________________________________________.

(name of member or member-owner )

The member or member-owner earned benefits under a pension plan subject to The Pension Benefits Act of

Manitoba (Act) and was employed in Manitoba on the day he or she ceased to be an active member of the plan.

I understand that under the Act



I am entitled to a joint survivor pension on the member’s death that must be at least 60% of the pension

payment that was payable to the member;



I may waive my entitlement to the joint survivor pension after receiving certain information and completing

this waiver;



if I sign this waiver I will no longer be entitled to the joint survivor pension on the member’s death that

must be at least 60% of the pension payment that was payable to the member;



this waiver may be revoked before the retirement of the member or member-owner by filing with the

administrator a written revocation signed by me.

I also understand that under the Act



a pension plan may allow a member to elect to receive an integrated pension;



the member cannot make the election without my consent;



if I sign this consent and the member chooses an integrated pension the joint pension payable to the

spouse or common law partner after the member’s death may be decreased by more than 40%.

I certify that



I have read this waiver and understand it;



I have read the member’s retirement statement or a statement from the financial institution showing the

balance in the owner’s account and know the amount of the benefit I am giving up;



I am aware of the consequences of waiving the joint survivor pension, and despite the consequences, I

waive it;



if relevant to me, I am aware of the consequences of consenting to the election of an integrated pension,

and despite the consequences, I consent to it;



I am not living separate and apart from the spouse or common-law partner by reason of a breakdown of

our relationship;

FORM 5 - Waiver of 60% Joint Pension Entitlement for Pension Plan or Locked-In Retirement Account

MAY 2012

Office of the Superintendent – Pension Commission

Form 5 - Waiver Of 60% Joint Pension Page 3

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