FSCO Family Law Form 8
Financial Services
Commission
of Ontario
Post-retirement Waiver of Joint and Survivor Pension
by the Former Spouse of a Retired Member
on Spousal Relationship Breakdown
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.
For Plan
Administrator
Use
FSCO 1321E (2016-03-01)
© Queen's Printer for Ontario, 2016
Page 1 of 3
Part A
Former Spouse of the Retired Member Information
i
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)
i
Part B
Retired Member Information
Last Name
First Name and Initials
Retired Member's Employee/Pension Plan Identification Number
i
Fax 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)
City
Apt./Unit No.
Province
Postal Code
For Plan
Administrator
Use
FSCO 1321E (2016-03-01)
© Queen's Printer for Ontario, 2016
Page 2 of 3
Part D
Waiving My Right to Receive the Survivor Benefit Payable to Me
After the Death of the Retired Member
My 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:
i
My final settlement instrument (court order, family arbitration award or domestic
contract) includes the waiver of the joint and survivor pension on page:
I understand that:
i
• 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.
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. i
Name of Former Spouse of the Retired
Member (print)
Signature of Former Spouse of the Retired
Member
Name of Witness (print)
Signature of Witness
Date (yyyy-mm-dd)
Date (yyyy-mm-dd)
Witness Contact Information
Mailing Address (Street Number and Name)
City
Apt./Unit No.
Province
Postal Code
Telephone Number (Main)
For Plan
Administrator
Use
FSCO 1321E (2016-03-01)
© Queen's Printer for Ontario, 2016
Page 3 of 3