R-15.1, r. 6 - Regulation respecting supplemental pension plans

Schedule Disposition versions

2012-09-01

SCHEDULE 0.1

(s. 15.4)

DECLARATION OF THE MEMBER OR THE SPOUSE

I declare that I am not now receiving any temporary income under any other supplemental pension plan subject to or established by an act of the Parliament of Québec or any other legislative authority or under an annuity purchase contract of which the capital comes directly or not from such a plan.

I declare furthermore that no other application intended to allow me to receive a temporary income from such a plan or contract has been made or accepted.

__________(Date)__________ __________(Signature)__________

NOTE: Whosoever makes a false declaration with the intention of obtaining a temporary income payable under a pension plan or contract mentioned in this declaration is subject to the penalties provided for in sections 257 and 262 of the Supplemental Pension Plans Act (chapter R-15.1).

O.C. 1681-97, s. 25; O.C. 173-2002, s. 67.