Domestic Partners Affidavit For Pension Fund

Note: Federal law does not recognize the existence of a same-sex marriage or domestic partnership relationship. Accordingly, same-sex spouses are not entitled to certain benefits reserved for individuals recognized as “spouses” under federal law. For example, a same-sex spouse is not entitled to the protections of the spousal waiver and qualified domestic relations order provisions of the Internal Revenue Code and the Employee Retirement Income Security Act of 1974, as amended. Accordingly, your same-sex spouse will be treated as a “domestic partner” for purposes of pre-retirement benefits available under the Equity-League Pension Plan.

You must follow these instructions if you wish your domestic partner to be eligible to receive a lifetime survivor annuity should you die pre-retirement and before your domestic partner. These instructions must be followed even if you are married in a state that recognizes same-sex marriages.

Please note that because the Equity-League Pension Plan now allows a participant to identify any beneficiary he/she chooses as his/her beneficiary for the post-retirement pension benefit, a participant is not required to execute the domestic partner affidavit in order for the domestic partner to be named as the beneficiary to the participant’s post-retirement pension benefit.

Designation of Domestic Partner to Receive Pre-Retirement Survivor Annuity

1) The participant must complete and NOTARIZE the forms labeled “Equity-League Pension and Health Fund Affidavit of Domestic Partnership” and “Attachment 1, Declaration of Financial Interdependence.” Please note that if your state or municipality allows the registering of Domestic Partners you must register with such state or municipality and attach a copy of the registration to the Affidavit. If you submit proof of Domestic Partner registration or a certificate of marriage (from a jurisdiction legalizing same-sex marriage), you do not need to submit the Declaration of Financial Interdependence or further proof of financial interdependence.

2) You must designate your domestic partner as your beneficiary. If you have not already done so, request a beneficiary form from the Fund Office and enclose it with your application.

3) Please mail the competed forms and premium to:

Equity League Pension Trust Fund
165 West 46 St, Suite 402
New York, NY 10036.

4) The Fund Office will process your application. If additional information is required in order to process your request, the Fund Office will contact you.

5) In order for you to name your domestic partner as your beneficiary to your pre-retirement pension benefit, you must:

If these conditions are satisfied, your domestic partner will receive the Fund’s retirement survivor annuity if you die before you retire.

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EQUITY-LEAGUE HEALTH FUND DOMESTIC PARTNER COVERAGE

1. Definition of Domestic Partners

Equity-League Health Fund defines domestic partners as follows:

Two adults (both of whom are 18 years or older) of the same or opposite sex, neither of whom is married (to anyone other than the domestic partner) or legally separated who:

a) either:

b) are not related by blood closer than the law would permit by marriage;

c) are financially dependent on each other;

d) have an exclusive close and committed relationship with each other;

e) have not terminated the domestic partnership; and

f) if eligible under (a)(i) above, and living in a state or municipality providing for the registration of domestic partnerships, have registered as domestic
partners.

2. Procedure for Verifying Domestic Partner Status

A participant who seeks domestic partner coverage is required to submit an affidavit attesting to the domestic partner status and a declaration of financial interdependence with two items of proof (such as joint lease or mortgage, joint bank account). (A sample affidavit and declaration is attached).

Persons who fraudulently, wrongfully (or negligently) obtain coverage for persons who are not entitled to such coverage, or who fail to timely notify the Plan Administrator of the termination of a domestic partnership, may be subject to disciplinary and/or civil action. You will be required to refund the Fund Office for the costs associated with the wrongfully extended coverage.

In addition, those who live in states or municipalities offering a domestic partner registry (such as California and New York City) will be required to show proof that they have registered as domestic partners.

3. Domestic Partner Coverage for Pre-Retirement Benefit

If you submit the beneficiary designation form and designate your domestic partner as your beneficiary for pre-retirement benefits, your domestic partner will receive a pre-retirement survivor annuity under the Plan if you die after you are vested but before you retire, provided you satisfied the Fund’s definition of a domestic partner for at least twelve months prior to your death. If you are vested and die before satisfying the domestic partner definition for at least twelve months but have designated your domestic partner as a beneficiary, your domestic partner will be entitled to the applicable death benefit for a single participant.

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4. Modification and Interpretation

The Trustees reserve the right to amend or modify the eligibility requirements for domestic partner coverage and to amend, modify or terminate domestic partner coverage at any time for any reason. The Trustees reserve the right to interpret all plan documents concerning domestic partner coverage and to interpret the requirements for and extent of such coverage.

Domestic Partners Affidavit Form For Pension Fund

Declaration of Financial Interdependence For Health Fund