Page 1 of 3FSCO 1321E (2016-03-01) © Queen's Printer for Ontario, 2016

For Plan Administrator

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Financial ServicesCommission of Ontario Post-retirement Waiver of Joint and Survivor Pension

by the Former Spouse of a Retired Member on Spousal Relationship Breakdown

FSCO Family Law Form 8

Approved by the Superintendent of Financial Services pursuant to the Pension Benefits Act, R.S.O. 1990, c. P.8

WHAT YOU NEED TO KNOW BEFORE COMPLETING THIS FORM

• Read the User Guide and Questions and Answers before completing this Waiver Form.

• Waiving your right to the joint and survivor pension means you will not receive a survivor benefit on the death of your former spouse (the Retired Member). You should get independent legal advice before completing this Waiver Form.

• If you are the former spouse (married or common-law) of a retired member and you want to waive your right to receive the survivor benefit that is payable to you on his or her death, you must complete this Waiver Form.

• You can only use this Waiver Form if ALL of the following conditions apply to you:

○ There has been a breakdown in your spousal relationship.

○ You were the spouse of the Retired Member on the date when the first instalment of his or her pension was due.

○ The pension valuation and division rules that came into effect on January 1, 2012 apply to you.

○ You have received your Statement of Family Law Value (FSCO Family Law Form 4E) and you are identified as the spouse in Part D (Spouse/Former Spouse of Retired Member Information).

○ The waiver is included in your final settlement instrument (court order, family arbitration award or domestic contract).

○ The pension has not already been divided.

• By completing this Waiver Form, you are ONLY waiving your right to receive a survivor benefit payable on the death of the Retired Member, which includes any guarantee payments that are attached to the joint and survivor pension.

• You are NOT waiving your right to receive a share of the Retired Member’s pension prior to his or her death.

• You and your lawyer should confirm with the Plan Administrator how the waiver is addressed under the terms of the pension plan and its effect (if any) on your share of the pension. Depending on the terms of the pension plan, waiving your right to the joint and survivor pension may not benefit you or the Retired Member.

• Your final settlement instrument must specify that you are waiving your right to the joint and survivor pension that would otherwise be payable to you upon the death of the Retired Member.

• If your final settlement instrument also provides for the division of the pension, send the Waiver Form, along with your Application to Divide a Retired Member’s Pension (FSCO Family Law Form 6) and the certified copy of your final settlement instrument, to the Plan Administrator.

• If the pension is not going to be divided, send the Waiver Form, along with the certified copy of your final settlement instrument, to the Plan Administrator.

• This Waiver Form cannot be processed without your final settlement instrument, which must include your waiver of the joint and survivor pension.

• Send your completed Waiver Form to the Plan Administrator. DO NOT SEND YOUR WAIVER FORM TO THE FINANCIAL SERVICES COMMISSION OF ONTARIO (FSCO).

• You CANNOT CANCEL this Waiver Form after you have given it to the Plan Administrator.

Page 2 of 3FSCO 1321E (2016-03-01) © Queen's Printer for Ontario, 2016

For Plan Administrator

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Part A Former Spouse of the Retired Member Information

Last Name First Name and Initials Date of Birth (yyyy-mm-dd)

Mailing Address (Street Number and Name) Apt./Unit No.

City Province Postal Code

Telephone Number (Main) Telephone Number (Other) Fax Number

Part B Retired Member Information

Last Name First Name and Initials

Retired Member's Employee/Pension Plan Identification Number Date of Birth (yyyy-mm-dd)

Part C Pension Plan Information

Name of Pension Plan

Plan Registration Number Plan Administrator

Mailing Address (Street Number and Name) Apt./Unit No.

City Province Postal Code

Page 3 of 3FSCO 1321E (2016-03-01) © Queen's Printer for Ontario, 2016

For Plan Administrator

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Part D Waiving My Right to Receive the Survivor Benefit Payable to Me

After the Death of the Retired MemberMy former spouse, who is the Retired Member identified in Part B of this Waiver Form, is currently receiving a joint and survivor pension under the pension plan that is identified in Part C of this Waiver Form.

I am the person who will be entitled to receive the survivor benefit should the Retired Member die before me.

The value of my survivor benefit, as shown in Part A (Family Law Value Summary) of the Statement of Family Law Value (FSCO Family Law Form 4E), is:

My final settlement instrument (court order, family arbitration award or domestic contract) includes the waiver of the joint and survivor pension on page:

Date (yyyy-mm-dd)Name of Former Spouse of the Retired Member (print)

Date (yyyy-mm-dd)Name of Witness (print)

Postal CodeProvinceCity

Apt./Unit No.Mailing Address (Street Number and Name)

Telephone Number (Main)

Witness Contact Information

Signature of Former Spouse of the Retired Member

Signature of Witness

• I am entitled to be paid a survivor benefit from the pension plan if the Retired Member dies before me.

• I am ONLY giving up my right to receive the survivor benefit from the pension plan, which includes any guarantee payments that are attached to the joint and survivor pension and that I will not receive a survivor benefit after the death of the Retired Member.

• I am NOT giving up any right I may have to receive a share of the Retired Member's pension under the terms of my final settlement instrument.

• If I am entitled to receive a share of the Retired Member's pension (as set out under the terms of my final settlement instrument), I will receive my share of the pension while the Retired Member is alive.

• Giving up my right to receive a survivor benefit will not result in the Retired Member's pension payments increasing unless the terms of the pension plan provide for such an increase.

• If there is no increase (or only a partial increase) in the Retired Member's pension payments, the value that I am giving up (or the difference) will remain in the pension plan and neither I nor the Retired Member may claim that value from the pension plan.

• I cannot change my mind once I have signed this Waiver Form and given it to the Plan Administrator.

I understand that:

By signing this Waiver Form in front of the witness identified below, I WAIVE (i.e. GIVE UP) my right to a joint and survivor pension and acknowledge that I WILL NOT receive a survivor benefit from the pension plan after the death of the Retired Member.