Attachment 4 - Technical Exhibt Affidavit of Domestic Partnership.pdf
PDF 19 KB Posted
- Attached to
- OCC's Group Life Insurance Services
- Solicitation number
- 2031JW24N00005
About this file
The document provided is an Affidavit of Domestic Partnership. It outlines the requirements for two individuals to certify that they are in a close, committed personal relationship and share the same regular and permanent residence. The affidavit must be signed by both partners and notarized. It states that if any of the information provided is found to be untrue, the relocation benefits for which the affidavit is being submitted may be rescinded, and the partners will be liable for repayment of the relocation expenses.
The related federal contract opportunity is a pre-solicitation notice from the United States Office of the Comptroller of the Currency (OCC) for group life insurance services. The OCC is conducting market research to determine the feasibility of a potential procurement requirement, with the primary NAICS code being 524113 - Direct Life Insurance Carriers. The government is seeking to gain knowledge of interested sources with the capabilities and qualifications to underwrite and administer its group life insurance program. This pre-solicitation notice does not constitute a formal solicitation, and the OCC will not pay for any costs associated with responding to it.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment 5- Technical Exhibit OCC Life Claims September 2021 through December 2023.xlsx | XLSX spreadsheet | |
| Attachment 6- Technicla Exhibit OFR Census.xlsx | XLSX spreadsheet | |
| SSN 2031JW24N00005-Life Ins_final2.pdf | ||
| Attachment 3 - Technical Exhibit Retiree Census - 02292024.xlsx | XLSX spreadsheet | |
| Attachment 1-Blank OCC Group Life Pricing Structure.pdf | ||
| Attachment 2 - Technical Exhibit Active Employee Census Data.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Affidavit of Domestic Partnership Section 1: Domestic Partner Statement
The undersigned, being duly sworn, depose and declare as follows:
We are each eighteen years of age or older and mentally competent.
We are not related by blood in a manner that would bar marriage under the laws of the State of ___________________________.
We have a close and committed personal relationship, and we are each other’s sole domestic partner not married or partnered with any other spouse, spouse equivalent or domestic partner.
For at least six months we have shared the same regular and permanent residence in a committed relationship and intend to do so indefinitely.
Section 2: Domestic Partner Signatures
Each of us agrees to notify the OCC if there is any change in our status as domestic partners as attested to in this Affidavit.
Each of us understands and agrees that in the event any of the statements set forth herein are not true, the relocation benefits for which this Affidavit is being submitted may be rescinded and/or each of us shall jointly and severally be liable for repayment of relocation expenses reimbursed by the employer.
Print name Print name
Signature Signature
Section 3: Notary Public Acknowledgment
The foregoing document was acknowledged before me this ________ day of ________________________, 20__ by _____________________________________.
Notary Public
Affidavit of Domestic Partnership
| Print name_2: |
| Print name: |
| State: |
File details come from the government source that posted it. Updated .