Form 4 - Spouse'S Waiver Of Beneficiary Right To Benefits In A Pension Plan, Locked-In Retirement Account, Life Income Fund Or Annuity Before Payments Start Page 2
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3I confirm the following:
1.
I am the spouse of the member/former member. Being the member’s/former member’s “spouse”
means
(a) I am married to the member/former member and have not been living separate and apart from
that person for a continuous period longer than 2 years immediately preceding the date on
which I sign this form, or
(b) I have been living with the member/former member in a marriage-like relationship for a
period of at least 2 years immediately preceding the date on which I sign this form.
2.
I understand that because I am the member’s/former member’s spouse, the Pension Benefits
Standards Act and the regulations under that Act give me the right to receive the following
survivor’s benefits:
(a) before pension or annuity payments start – I have the right as beneficiary, after the
member’s/former member’s death, to receive the member’s/former member’s benefits in the
pension plan and any locked-in retirement account, life income fund or annuity purchased
using those benefits, unless I waive or give up that right by signing this form;
(b) after pension or annuity payments start – If the member/former member starts receiving a
pension or payments from an annuity purchased using his or her benefits in a pension plan,
locked-in retirement account or life income fund,
(i) I have the right after the member’s/former member’s death to receive lifetime payments,
that are at least 60% of the payments that were paid to the member/former member,
unless I waive or give up that right by signing Form 2 [Spouse’s Waiver of 60% Lifetime
Survivor Benefit and/or Beneficiary Rights From a Pension Plan or Annuity After
Payments Start], and
(ii) even if I waive or give up the right to receive those lifetime payments, I still have the
right as beneficiary, after the member’s/former member’s death, to receive any remaining
benefits in the pension or annuity unless I waive or give up that right by signing Form 2
[Spouse’s Waiver of 60% Lifetime Survivor Benefit and/or Beneficiary Rights From a
Pension Plan or Annuity After Payments Start].
3.
I understand that signing this form does not affect
(a) the rights I have under the Pension Benefits Standards Act set out in section 2 (b) of this form
unless I waive or give up those rights, or
(b) any rights I may have as a result of a breakdown of the relationship between me and the
member/former member.
4.
I understand that
(a) my survivor’s benefits may have substantial value and may be important to provide me with
income in my old age, and
(b) if I sign this form,
(i) I will receive no benefits from the pension plan, locked-in retirement account, life
income fund or annuity if the member/former member dies before starting to receive
pension or annuity payments, and
(ii) any benefits payable on the member’s/former member’s death will be paid to the
beneficiary that the member/former member designates or, if no beneficiary is designated,
to the personal representative of the member’s/former member’s estate.
5.
I have read this form and understand it.
6.
I have reviewed current statements of the member’s/former member’s benefit entitlement provided
by the plan administrator, locked-in retirement account issuer, life income fund issuer or insurance
company holding the annuity.
7.
Neither the member/former member nor anyone else has put any pressure on me to sign this form.
8.
The member/former member is not present while I am signing this form.
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