Fillable Separation Declaration Parents Of Dependent Students printable pdf download

In the matter of the Saskatchewan Student Aid Fund; and in the matter of a Student Loan Application

Separation Declaration

Student Service Centre

1120 - 2010 12th Avenue

Regina, Canada S4P 0M3

306-787-5620

Parents of Dependent Students

1-800-597-8278

Fax: 306-787-1608

For Office Use Only

File No.

Student’s Post-Secondary

Student’s Full

Education No.: __________________________

Name

: ______________________________________

(please print)

I, ____________________________________________________, of ________________________, ________________.

(Full name of parent)

(City/Town/Village)

(Province)

Declare that

1. I was married to, or was living common-law with ____________________ on/from the ___ day of _____, 20___

(name of former spouse)

at _____________________________________. There are ______ children of the marriage, namely:

(city and province)

________________________________________________________________________________________________.

(names of all children)

2. I began living seperate and apart from my said spouse on or about the _____ day of ________, 20____, and

have continued to live separate and apart from my said spouse since that date.

3. Effective the _____day of _______, 20_____, at the start date of my course, I have (check one):

… full-time custody of my children who will be living with me full-time, or

… 50% custody, or

… less than 50% custody,

of the following children: ______________________________________________________________________

Please indicate Yes or No to question 4 through 7.

4. (a) Do you have a written separation agreement between yourself and your spouse?

 Yes  No

If yes: What is the amount per month you receive for child support/alimony under this agreement? $______

per month (Attach a copy of this written agreement to this Declaration)

(b) Do you have an oral separation agreement between yourself and your spouse?

 Yes  No

If yes: What is the amount per month you receive for child support/alimony under this agreement? $______

per month

5. Are you paying child support?

 Yes  No

If yes: What is the monthly amount you pay? $______ per month

Date these payments came into effect the ____ day of _______, 20_____

6. Were there assests which were divided between yourself and your spouse?

 Yes  No

If yes: Attach a list of the division of assests.

7. Are you co-habitating (living common-law) at the present time?

 Yes  No

If yes: Indicate the full name of common-law spouse _____________________________________

8. I declare that the said separation is due to marital breakdown and not geographic location or other reasons.

And I make this Declaration conscientiously, believing it to be true, and knowing it is of the same force and

effect as if made under Oath and by virtue of the Canada and Saskatchewan Evidence Acts.

X ______________________________

____________________________

Signature of Student

Date

saskatchewan.ca/studentloans | 1-800-597-8278

AI024-0614

Separation Declaration Parents Of Dependent Students

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