DECLARATION OF THE MEMBER OR THE SPOUSE
(1) that I am not a party to any contract establishing a life income fund or locked-in retirement account or any registered retirement savings plan of which the balance must be converted into a life annuity (locked-in RRSP);
(2) that the total amount of the temporary pensions, variable benefits and temporary variable payments that I will receive during the current year under the following contracts:
(a) supplemental pension plans subject to or established by an act of the Parliament of Québec or any other legislative authority;
(b) annuity purchase contracts of which the capital comes directly or not from such a plan;
(c) the voluntary retirement savings plans governed by the Voluntary Retirement Savings Plans Act (chapter R-17.0.1) or an equivalent voluntary retirement savings plan emanating from a legislative authority other than the Parliament of Québec,
NOTE: Whosoever makes a false declaration with the intention of obtaining the lump-sum payment provided for in section 92 of the Act is subject to the penalties provided for in sections 257 and 262 of the Supplemental Pension Plans Act (chapter R-15.1).