FORM 1:  Claim of Spouse to Interest in Member's Pension
                 Family Relations Act, section 82   

______________________________________________________________________________

         To:    Administrator of pension plan 

          Name of Plan:          ________________________________________________

          Address of Plan:       ________________________________________________

          (please print)         ________________________________________________

______________________________________________________________________________

          From:    Spouse of member (Note:  "spouse"  includes a former spouse.)

          Name:        ________________________________________________

          Address:     ________________________________________________

          Telephone:   (home) _________________  (work) __________________

          Social Insurance No.: _______________________ 

______________________________________________________________________________

          In relation to:     Plan member 

          Name of member:    ________________________________________________ 

          Address:           ________________________________________________

                             ________________________________________________

          Telephone:  (home) __________________ (work) _________________     

          Social Insurance or Pension Plan Identity Number:________________________

          Employer:          ________________________________________________

______________________________________________________________________________

Declaration of Spouse Claiming Interest 

I, ____________________________________ (name of spouse) declare that 

(a)  I was married to the member named above on _______________________ (date), 

(b)  I was separated from the member on ________________________ (date), and 

(c)  I am claiming an interest in the member's pension based on section 56 (1) of the

Family Relations Act (see below). 


                 ______________________________________      _______________________
                 Signed (spouse)                               Date of declaration


                         ______________________________________
                         Signed (Witness to signature of Spouse)


          Name of Witness:    ____________________________________________

          Address of Witness: __________________________________________  

______________________________________________________________________________

Family Relations Act, section 56: 
(1)  Subject to this Part and Part 6, each spouse is entitled to an interest in each family asset on or after March 31, 1979, when  
(a) a separation agreement,
(b) a declaratory judgment under section 57, 
(c) an order for dissolution of marriage or judicial separation, or
(d) an order declaring the marriage null and void 
respecting the marriage  is first made.