Statement of imputed value — form and contents
 24. (1) A statement of imputed value, to be provided under subsection 67.2 (9) of the Act, must be set out on a form approved by the Chief Executive Officer.  O. Reg. 287/11, s. 24 (1); O. Reg. 155/19, s. 1 (1). (2) Background information: The following background information must be included in the statement: 1.  Particulars identifying the pension plan and the administrator. 2.  The name and date of birth of each spouse. The statement must also indicate which spouse is the member, former member or retired member of the pension plan and, if applicable, which spouse is entitled to a pension payable on the death of the retired member. 3.  The employment and membership status as of the family valuation date, for the purposes of the pension plan, of the spouse who is the member, former member or retired member. The statement must also indicate when he or she became a member and, if applicable, when he or she became a former member or retired member, respectively. 4.  The starting date used for determining the imputed value of the pension benefits, deferred pension or pension.  The statement must indicate whether the starting date is the spouses’ date of marriage, the date on which their cohabitation began or another date chosen jointly by the spouses. 5.  The spouses’ family law valuation date or, if applicable, the proposed valuation dates under section 22.  O. Reg. 287/11, s. 24 (2). (3) Preliminary valuation: The preliminary value for family law purposes of the pension benefits, deferred pension or pension, including, where applicable, the pension payable to the spouse of a retired member upon the death of the retired member, and the particulars of the information used and assumptions relied upon to determine the preliminary value must be set out in the statement.  O. Reg. 287/11, s. 24 (3). (4) Imputed value: The imputed value of the pension benefits, deferred pension or pension, including, where applicable, the pension payable to the spouse of a retired member upon the death of the retired member, must be set out in the statement.  O. Reg. 287/11, s. 24 (4). (5) Related financial matters: The following additional information about related matters must be included in the statement: 1.  The accumulated amount of any additional voluntary contributions made by the member or former member on or before the family law valuation date, including interest on those contributions. 2.  If available, the accumulated amount of any additional voluntary contributions made by the member or former member between the spouses’ starting date and family law valuation date, including interest on those contributions. 3.  The amount of any lump sum payable to the former member or retired member under subsection 39 (4) of the Act, determined as of the family law valuation date.  O. Reg. 287/11, s. 24 (5). (6) Options for spouse: The following information about the options available in the circumstances to the former spouse of a member, former member or retired member must be included in the statement: 1.  If applicable, a description of the options available to the former spouse under subsection 67.3 (2) of the Act for transferring a lump sum from the pension plan. The statement must also indicate how the former spouse applies for a transfer and indicate the information that he or she will be required to provide in such an application. 2.  If applicable, a description of the option available to the former spouse under subsection 67.4 (2) of the Act for a division of the retired member’s pension and for payment of the former spouse’s share to him or her. The statement must also indicate how the former spouse applies for a division and indicate the information that he or she will be required to provide in such an application. 3.  If applicable, a description of the option available to the former spouse under subsection 67.4 (10) of the Act to request payment of a single pension instead of payment of a share of the retired member’s pension and payment of a pension on the death of the retired member. The statement must also indicate how the former spouse applies for payment of a single pension and indicate the information that he or she will be required to provide in such an application.  O. Reg. 287/11, s. 24 (6). (7) General information: The following general information about the pension plan must be included in the statement: 1.  An explanation of the provisions of the plan that apply to the member, former member or retired member or to a spouse entitled to a pension payable on the death of the retired member. 2.  The transfer ratio of the plan as of the valuation date of the most recent report under section 3 or 14 of the General Regulation that was filed with the Chief Executive Officer before the date of the statement of imputed value. 3.  If applicable, particulars relating to the wind up of the pension plan if the effective date of the wind up is on or before the date of the statement of imputed value. 4.  If applicable, particulars relating to a partial wind up of the pension plan if the member, former member or retired member is affected by the partial wind up and if the effective date of the partial wind up is on or before the date of the statement of imputed value. 5.  If applicable, particulars of any application to the Chief Executive Officer on or before the family law valuation date for payment of surplus out of the pension fund to a class of employees that may include the member, former member or retired member, if the Chief Executive Officer has not consented to the application on or before the family law valuation date. 6.  If applicable, an explanation of any amendment made to the pension plan that resulted in the payment, during the three fiscal years of the plan before the family law valuation date, of a cost of living adjustment to the class of employees to which the member, former member or retired member belongs.  O. Reg. 287/11, s. 24 (7); O. Reg. 155/19, s. 1 (1). (8) A certificate of the administrator — certifying that the information in the statement is accurate, based on the information provided by the applicant and the information contained in the records of the pension plan — must be included in the statement.  O. Reg. 287/11, s. 24 (8).