R-15.1, r. 6 - Regulation respecting supplemental pension plans

Full text
(s. 31)
I declare that I am not now receiving any temporary income under a supplemental pension plan subject to or established by an act of the Parliament of Québec or any other legislative authority or under any other annuity purchase contract of which the capital comes directly or not from such a plan.
I further declare that no other application intended to allow me to receive a temporary income from such a plan or contract has been made or accepted.
__________(Date)__________ __________(Signature)__________
NOTE: Whosoever makes a false declaration with the intention of obtaining a temporary income payable under a contract mentioned in the declaration is subject to the penalties provided for in sections 257 and 262 of the Supplemental Pension Plans Act (chapter R-15.1).
O.C. 1681-97, s. 25.