Application for Partition of Employment Earnings Between Former Spouses (RDC003A)

Description

Application for Partition of Employment Earnings Between Former SpousesUsing this form, both former spouses can apply for partition of the employment earnings recorded under their names in the Québec Pension Plan and, if applicable, in the Canada Pension Plan for the period of their union.Please print 1. Identification of former spouses Spouse ASex Family name Given name Social insurance number F Language of correspondence Born in Québec Date of birth M year month day French English Yes NoMother’s family name at birth Mother’s given nameYour address (number, street, apt.)City Province Country Postal codeTelephonearea code area codeHome Other Extension Spouse BSex Family name Given name Social insurance number F Language of correspondence Born in Québec Date of birth M year month day French English Yes NoMother’s family name at birth Mother’s given nameYour address (number, street, apt.)City Province Country Postal codeTelephonearea codearea codeHome Other Extension 2. Information on your union2.1 Were the persons identified in section 1 married or in a civil union? No. Give the starting and ending dates for the period you lived together:Date you started Date you stoppedliving together living togetheryear month day year month dayDate of the judgment of divorce, Yes. Provide the following information: separation from bed and Date on which the application for board, annulment of marriage divorce, separation from bed and board, ...

Informations

• Publié par: Orgie
• Nombre de lectures: 51
• Langue: English

Extrait

Régie des rentes du Québec

RDC-003A (10-12)

Spouse B

Using this form, both former spouses can apply for partition of the employment earnings recorded under their names in the

Québec Pension Plan and, if applicable, in the Canada Pension Plan for the period of their union.

Please print

1. Identification of former spouses

Sex

Family name

Given name

Social insurance number

F

M

Language of correspondence

Born in Québec

Date of birth

French

English

Yes

No

Mother’s family name at birth

Mother’s given name

Your address

(number, street, apt.)

City

Province

Country

Postal code

Telephone

Home

Other

Extension

Application for Partition of Employment Earnings Between Former Spouses

Sex

Family name

Given name

Social insurance number

F

M

Language of correspondence

Born in Québec

Date of birth

French

English

Yes

No

Mother’s family name at birth

Mother’s given name

Your address

(number, street, apt.)

City

Province

Country

Postal code

Telephone

Home

Other

Extension

Spouse A

2. Information on your union

2.1 Were the persons identified in

section 1

married or in a civil union?

No. Give the starting and ending dates for the period you lived together:

Yes. Provide the following information:

If the judgment was rendered outside Québec, please provide a certified copy of the judgment and, if applicable, any

agreements reached between the former spouses. If you have a separation agreement, please provide a copy.

Date you stopped

living together

Date you started

living together

area code

area code

year

month

day

area code

area code

Date of marriage or

civil union

Date of the judgment of divorce,

separation from bed and

board, annulment of marriage

or dissolution of civil union or

separation agreement

Date on which the application for

divorce, separation from bed and board,

annulment of marriage or dissolution of

civil union was filed with the Court

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

Régie des rentes du Québec

RDC-003A (10-12)

2. Information on your union (continued)

2.2 Were there any periods of separation during the time you lived together?

No. Go to

question 2.3

.

Yes. Give the starting and ending dates for each period of separation.

From

To

From

To

2.3 Was a child born or is a child to be born of your union or did you adopt a child during the time you lived together?

No. Go to

section 3.

Yes. Provide the following information for one such child:

Family name

Given name

Date of birth

Date of adoption

3. Additional information

Has either one of you ever been married to or in a civil union with

a person other than

the person identified in section 1?

No. Go to

section 4

.

Yes. Provide the following information:

Spouse A

(as identified in

section 1

)

Spouse B

(as identified in

section 1

)

4. Declaration and signatures

Both former spouses must sign only if you are applying for partition of employment earnings for a period during which

you were in a de facto (common-law) union.

We declare that all information shown on this form is correct.

Signature (Spouse A)

Date

(as identified in

section 1

)

Signature (Spouse B)

Date

(as identified in

section 1

)

Return to: Régie des rentes du Québec

C. P. 5200, Québec (Québec)

G1K 7S9

Access to documents held by public bodies and the protection of personal information

The personal information collected on this form is needed to study your application. Failure to provide this information may result in a

delay or a refusal to process your application. Only authorized employees have access to the information and it is only disclosed to other

persons or agencies for verification in cases provided for by law. It can also be used for research, assessment, analysis or survey purposes.

The

Act respecting Access to documents held by public bodies and the Protection of personal information

allows you to consult your

personal information and have it corrected.

Date of marriage

or civil union

Date of judgment of divorce,

annulment of marriage or

dissolution of civil union

Date of this

other person’s death

(if applicable)

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day

year

month

day