Separation of a couple

Application for a Statement of Benefits for Former De Facto (Common Law) Spouses

This form allows a person to request a Statement of Benefits regarding a voluntary retirement savings plan (VRSP) or a supplemental pension plan in the private, municipal or university sectors.

This form concerns former spouses who:

  • were recognized de facto spouses
  • no longer live together
  • would both like to know the total value of the benefits on the date on which they stopped living together.
If needed, consult the table of forms for requesting a Statement of Benefits.
rcr-138 form. Last update: February 2022.
Top of page