RCMP-GRC 2010E: Statutory declaration

Statutory declaration PDF, 312KB)

Protected "B" when completed

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This form is required for purposes of the Royal Canadian Mounted Police Superannuation Act and should be completed by the survivor or other person(s) having custody and control of dependant children.

In the matter of the Royal Canadian Mounted Police Superannuation Act
do solemnly declare:
That the dependant children (include stepchildren and adopted children) now alive of the said late plan member, and their birth dates are as follows:
That I have custody and control of all the above-named dependant children, or the following dependant children:
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.

Send completed declarations to:

Government of Canada Pension Centre—Mail facility
150 Dion Boulevard
PO Box 8500 
Matane QC  G4W 0E2

RCMP- GRC 2010E (2014-07-001)

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