Domestic Partners Statement of Relationship

Recognizing domestic partnerships is crucial for creating inclusive workplaces. The domestic partners statement of relationship form formalizes and acknowledges employees in committed domestic partnerships. This document shows an organization's commitment to diversity, equity, and inclusion. It provides clarity and support for employees in non-traditional family structures. Using this template can help promote a more inclusive workplace for all employees.

Domestic Partners Statement of Relationship Template

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:

1. We are each other’s sole domestic partner and intend to remain so indefinitely.
2. Neither of us is legally married to or the domestic partner of anyone else.
3. We share a close personal relationship and are responsible for each other’s welfare.
4. We are jointly responsible for our common welfare and financial obligations.
5. We have resided together in the same residence for at least six (6) months and intend to do so indefinitely.
6. We are both at least 18 years old and mentally competent to consent to contract.
7. We are not related by blood closer than would bar marriage in our state of residence.
8. 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.

Benefits of Domestic Partners Statement of Relationship

Equal Workplace Benefits

By acknowledging domestic partnerships through a formal Statement of Relationship, organizations can ensure that their employees in domestic partnerships receive the same benefits and rights as married couples. This includes health insurance coverage, bereavement leave, and retirement benefits. This promotes equality and inclusivity within the workplace, fostering a positive and supportive work environment for all employees.

Retention and Employee Satisfaction

Recognizing and supporting domestic partnerships can aid in retaining valuable employees. When employees feel that their personal relationships are respected and supported by their employer, they are more likely to feel valued and satisfied in their job. This can lead to higher employee morale, increased productivity, and decreased turnover rates within the organization.

Legal and Financial Protection

A Domestic Partners Statement of Relationship can provide legal and financial protection for individuals in domestic partnerships. It can outline important details such as shared assets, rights to decision-making in the event of medical emergencies, and inheritance rights. By formalizing these arrangements, organizations can ensure that both partners are legally protected and have access to necessary resources in times of need.

Diversity and Inclusion Initiatives

Implementing a Domestic Partners Statement of Relationship demonstrates an organization's commitment to diversity and inclusion. It sends a clear message that the organization values and respects individuals of all backgrounds and relationship statuses. This can help attract a more diverse talent pool, improve the organization's reputation, and create a culture of acceptance and respect.

Conclusion

In conclusion, the domestic partners statement of relationship is a valuable tool for organizations recognizing committed partnerships of employees. Its implementation shows commitment to creating an inclusive and supportive work environment. This boosts employee morale, engagement, and fosters loyalty.