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inclusion: Accommodating spouses/partners
:
Tips and Tools
Domestic Partner Agreement
The International Food Policy Research Institute (IFPRI) is one of the Centers that has developed a formal domestic partner agreement, its “Affidavit of Domestic Partnership”. Some other Centers are in the process of developing similar documents. IFPRI is headquartered in the USA, and its approach is strongly influenced by that country’s employment practices.
When a domestic partner agreement is introduced,
there needs to be a companion document covering the situation if the
partnership subsequently is dissolved. The IFPRI “Certification of Termination of Domestic
Partnership” has been introduced for this purpose, and is also
shown below.
IFPRI AFFIDAVIT OF DOMESTIC PARTNERSHIP
Employee Name______________________________________
Domestic Partner Name________________________________
I submit this Affidavit of Domestic Partnership to identify my Domestic Partner and to certify his/her status for the purpose of any benefits that IFPRI may extend to Domestic Partners.
We, the undersigned, declare the following:
- We are both at least the age of consent in the jurisdiction in which we reside.
- We are each mentally competent.
- We are not related by blood in a manner that would prohibit legal marriage.
- We are not legally married to or the common-law spouse or domestic partner of any other person.
- We have a close and committed personal relationship.
- For at least twelve months proceeding the date of this affidavit, we have shared the same regular and permanent residence in a committed, spouse-like relationship and intend to do so indefinitely.
- We are jointly responsible for each other's welfare and financial obligations.
We certify the following: [check either box as applicable]
We have a currently registered domestic partnership with a governmental
body pursuant to the country, state or local law authorizing such registration.
We are financially interdependent with each other and can prove such
interdependence by providing documentation of at least two of the following:
- common ownership of real property or a common leasehold interest in such property
- community ownership of a motor vehicle
- a joint bank account or a joint credit account
- designation as a beneficiary for life insurance or retirement benefits under partner’s will
- assignment of a durable power of attorney
or health care power of attorney
such other proof as is considered by IFPRI to be sufficient to establish financial interdependency under the circumstances of our particular case
We have provided true and accurate required documentation of our relationship. Each of us understands that we shall jointly and severally be liable for any expenses incurred or benefits provided by IFPRI, the insurer or health care entity as a result of any false or misleading statement contained in this Affidavit of Domestic Partnership. I (staff member) understand that I must complete all required enrollment forms to apply for Domestic Partner coverage. I (staff member) understand that I must file a Certification of Termination of Domestic Partnership with Human Resource Services within 30 days after the date on which any of the criteria of a domestic partnership relationship (as stated above) is not met.
Signature of Staff Member _______________________________
Signature of Domestic Partner_____________________________
Sworn before me this_________ day of_____________ ,
in the year________ .
NOTARY PUBLIC___________________________________________________
IFPRI Certification of Termination of Domestic
Partnership
Employee:________________________________________________
Former Domestic Partner:___________________________________
I submit this Certification of Termination of Domestic Partnership in order to cancel the Certificate of Domestic Partnership that I previously submitted.
I certify that my Domestic Partnership with my former domestic partner
identified above ended on:
____________________________________.
(Termination date or date of death)
I understand that my former Domestic Partner and his
or her dependents will no longer be covered by IFPRI’s benefits.
I understand that they have the right to apply for the continuation of
domestic partner benefits.
I will provide a copy of this signed Certification to my former Domestic
Partner, if still alive, within 14 days.
Signature of Staff Member____________________________ Date______________
Address of Staff Member________________________________________________
© CGIAR Gender & Diversity
Program 2006