Application for Simulated Partition of Employment Earnings (RDC002A)

Application for Simulated Partition of Employment Earnings - MediatorForm to be completed by the mediatorThis form must be completed in order to obtain a table for both spouses showing the employment earnings entered under the Québec Pension Plan and the Canada Pension Plan, if any. An estimate of the pension amounts before and after the simulated partition are also provided with the table. This will help the spouses make an informed decision regarding partition if they are considering ending their union.Access to documents held by public bodies and the protection of personal informationThe personal information collected on this form is needed to study your application. Failure to provide this information may result in a delay or a refusal to process your application. Only authorized employees have access to the information and it is only disclosed to other persons or agencies for verification in cases provided for by law. It can also be used for research, assessment, analysis or sur vey purposes. The Act respecting Access to documents held by public bodies and the Protection of personal information allows you to consult your personal information and have it corrected.Please print 1. Identification of spousesSpouse ASex Family name Given name F Date of birth Social insurance number His or her mother’s family name at birth (maiden name)year month day M Spouse BSex Family name Given name F Date of birth Social insurance number His or her mother’s ...