What is a Domestic Partners Statement Relationship?
The Domestic Partners Statement Relationship form is a crucial document that enables employees to formally declare their domestic partnership status. This form is particularly relevant when employees wish to qualify for specific benefits provided by your organization, such as health insurance, bereavement leave, and retirement plans. By recognizing domestic partnerships through this statement, you foster an inclusive work environment that supports diverse family structures and affirms your organization’s commitment to equity and respect.
Template
Below is a template you can customize for your organization’s needs:
Domestic Partners Statement of Relationship
This form is intended to verify the domestic partnership status of employees for the purposes of qualifying for certain benefits offered by [Organization Name]. Please complete the following information accurately.
Employee Information
Employee Name: __________________________________________
Employee ID: _____________________________________________
Department: ______________________________________________
Phone Number: ___________________________________________
Email Address: ____________________________________________
Domestic Partner Information
Partner’s Name: __________________________________________
Date of Birth: _____________________________________________
Address: _________________________________________________
Phone Number: ___________________________________________
Email Address: ____________________________________________
Statement of Domestic Partnership
We, the undersigned, declare that:
- We are each other’s sole domestic partner and intend to remain so indefinitely.
- Neither of us is legally married to or the domestic partner of anyone else.
- We share a close personal relationship and are responsible for each other’s welfare.
- We are jointly responsible for our common welfare and financial obligations.
- We have resided together in the same residence for at least six (6) months and intend to do so indefinitely.
- We are both at least 18 years old and mentally competent to consent to contract.
- We are not related by blood closer than would bar marriage in our state of residence.
- We understand that this domestic partnership must be established under the terms of [Organization Name]’s policies and that a false declaration may result in disciplinary action, including termination of employment and/or denial of benefits.
Documentation
We attach the following documentation as proof of our domestic partnership (check all that apply):
- Joint lease, mortgage, or deed
- Joint bank account
- Joint credit card
- Joint obligation (such as a car loan)
- Designation of the domestic partner as a primary beneficiary for a life insurance policy or retirement plan
- Designation of the domestic partner as a primary beneficiary in the employee’s will
- Other (please specify): ______________________________
Acknowledgment and Signature
We declare, under penalty of perjury, that the representations herein are true and correct and contain no material omissions of fact to the best of our knowledge and belief.
Employee Signature: _______________________________________ Date: ______________
Domestic Partner Signature: _______________________________ Date: ______________
Notary Public
State of ____________ County of ____________
Subscribed and sworn to before me on this ___ day of __________, 20__ by ______________________________ and ______________________________, who are personally known to me or who have provided satisfactory evidence of identity.
Notary Public Signature: ______________________________
My Commission Expires: ______________________________
For Internal Use Only
Received By: _____________________________________________ Date Received: ______________
Reviewed By: _____________________________________________ Date Reviewed: ______________
Approved/Denied: __________________________________________
Comments: ______________________________________________
This document is confidential and intended solely for the use of [Organization Name]. Unauthorized disclosure or misuse of this document is prohibited.
Purpose and Benefits
The Domestic Partners Statement Relationship serves multiple purposes, enhancing workplace inclusivity and support. Here are some key benefits:
- Equal Workplace Benefits: Formal recognition of domestic partnerships allows employees to access the same benefits as married couples, thus promoting fairness in the workplace.
- Retention and Employee Satisfaction: Supporting domestic partnerships can lead to higher employee morale and lower turnover rates, as employees feel valued and respected.
- Legal and Financial Protection: This statement clarifies important rights and responsibilities, providing protection for both partners in various situations.
- Diversity and Inclusion Initiatives: By recognizing diverse family structures, organizations can attract a wider talent pool and improve their reputation.
Essential Components
When creating a Domestic Partners Statement Relationship form, ensure it includes the following essential components:
- Employee Information: Basic details about the employee, which are necessary for record-keeping and benefits eligibility.
- Domestic Partner Information: Essential details of the domestic partner, which help verify the partnership.
- Statement of Domestic Partnership: A declaration that outlines the nature of the relationship, ensuring clarity and legal protection.
- Documentation Section: A checklist for necessary supporting documents that validate the partnership.
- Acknowledgment and Signature: Signatures of both partners affirming the truthfulness of the information provided.
- Notary Section: A section for notarization, if required, to add an extra layer of legal verification.
How to Use This Form
To implement the Domestic Partners Statement Relationship effectively, consider the following steps:
- Communicate Clearly: Inform all employees about the availability of this form and its importance in accessing benefits.
- Provide Guidance: Offer assistance in completing the form and gathering necessary documentation.
- Ensure Confidentiality: Treat all submitted forms with the utmost confidentiality to respect employees’ privacy.
- Review Regularly: Periodically review the form and associated policies to ensure they remain compliant with legal standards.
Legal and Compliance Considerations
It’s essential to stay informed about the legal landscape surrounding domestic partnerships. Ensure your form complies with local and state laws regarding domestic partnerships, including any specific requirements for benefits eligibility. Regularly consult with legal counsel to remain updated on any changes in legislation that may affect this policy.
Best Practices
To maximize the effectiveness of the Domestic Partners Statement Relationship, keep these best practices in mind:
- Regular Training: Train HR staff on how to handle these forms and understand the implications of domestic partnerships.
- Feedback Mechanism: Create a system for employees to provide feedback on the process, ensuring continuous improvement.
- Inclusive Language: Use inclusive language in all communications and documentation to foster an accepting environment for all employees.
