1. Any application to obtain a statement referred to in section 122.1 of the Act respecting the Government and Public Employees Retirement Plan (chapter R-10) shall contain the following information and be accompanied with the following documents:(1) the name, address, social insurance number and date of birth of the member or former member and of his spouse;
(2) in the case of married spouses, a marriage certificate and, where applicable, the date on which the spouses resumed living together;
(2.1) in the case of spouses in a civil union, a certificate of civil union;
(3) written confirmation from a certified mediator to the effect that he or she has received a mandate within the context of family mediation or written confirmation from a notary to the effect that the spouses in a civil union have undertaken a joint procedure for the dissolution of their civil union or, as the case may be, the joint declaration dissolving the civil union and the notarized transaction contract, or a copy of the application for separation from bed and board, divorce, annulment of marriage or civil union, dissolution of civil union or payment of a compensatory allowance or, where applicable, a copy of the judgment disposing of such an application;
(4) the information that must be provided by the employer in his annual report, in accordance with section 188 of the Act respecting the Government and Public Employees Retirement Plan for the year during which the assessment is determined up to the date set for that assessment, as well as for the previous year; that information shall be certified by an authorized representative of the employer.