Introduction

I, [YOUR NAME], hereby attest to the accuracy and truthfulness of the following statements made in this Spousal Eligibility Affidavit. This affidavit is issued to verify my marital status and eligibility to receive retirement benefits as the spouse of [SPOUSE'S NAME].

Statement of Facts

1. I, [YOUR NAME], am currently married to [SPOUSE'S NAME], and our marriage took place on [DATE OF MARRIAGE].

2. My spouse, [SPOUSE'S NAME], is an active participant in the retirement plan administered by [RETIREMENT PLAN ADMINISTRATOR'S NAME].

3. I am the legal spouse of [SPOUSE'S NAME] and have not entered into any other marriage, domestic partnership, or similar legal relationship that would affect my eligibility for spousal retirement benefits under the terms of the retirement plan.

Sworn Oath

I, [YOUR NAME], do hereby solemnly swear and affirm under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I understand that any false statements made herein may subject me to legal consequences.

[YOUR NAME]

Date: [DATE SIGNED]

Witness

I, the undersigned, hereby certify that [YOUR NAME] personally appeared before me, and I witnessed the signing of this Spousal Eligibility Affidavit.

[WITNESS NAME]

Date: [DATE SIGNED]

Notarization

This affidavit is executed and issued under the laws of the [STATE/COUNTRY OF ISSUANCE].

[NOTARY PUBLIC SEAL]

Notary Public

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