Skip to main content
Statement of Domestic Partnership Form Concepts
What's Included
$19 Template
$89 Pack
$199 Pro
This single static template
90 contract template library
Starter proposal template library
Novice quoting software
340 contract templates
700 proposal layouts
200 completed sample proposals
110 project templates
Expert quoting software
Document branding features

How to write your Statement of Domestic Partnership Form

We include this 3 page template with Human Resources Contract Pack and the Proposal Kit Professional. You will get more content and software automation for data merging, managing client documents, and creating proposals with line item quoting with a Contract Pack or the Professional.

Use the Employee Statement of Domestic Partnership Form for your employees who are in a living arrangement that affects their company insurance plan or other company benefits.
Document Length: 3 Pages
Quote Logo What Our Clients Say

Your products have provided me with a great basis to construct a workflow for my clients. As a freelancer, I cannot afford to hire a solicitor to write my contracts so using yours has saved me a lot of time and money."

Anthony Karolis

1. Get Human Resources Contract Pack or the single template that includes this business contract document.

We include this Statement of Domestic Partnership Form in editable Word format that can be customized using your office software.

2. Download and install after ordering.

Once you have ordered and downloaded your template or pack, you will have all the content you need to get started.

3. Customize the contract template with your information.

You can customize the contract document as much as you need. If you get a Contract Pack or Professional Bundle, you can also use the included Wizard software to automate name/address data merging.

Statement of Domestic Partnership Form

How to write my Statement of Domestic Partnership Form document

Statement of Domestic Partnership

Employee Name: First Last Employee SSN: Social Security Number Partner Name: Partners Name, Partner SSN: Partner Social Security Number, Department: Department Supervisor: Supervisor. Please complete the following form, signing both employee and partner's names on each line, and return it to the Human Resources Department.

We affirm or attest that we are:

At least 18 years of age:

Mentally competent and legally able to enter into a contract at the time this domestic partnership statement is completed:

The sole domestic partner to one another:

Sharing and co-habiting in a primary residence:

Not married to any other person (legal or otherwise) or of a blood relationship that would prohibit marriage in the State of State:

In a relationship of mutual caring, support, and commitment, and intend to remain in such a relationship for the foreseeable future:

Domestic Partnership Verification

Upon request, we understand that we may be asked to produce the following documents:

One of the following

A Domestic Partnership Certificate. A Domestic Partnership Registration. A Domestic Partnership Contract or Agreement entered into by both employee and partner.

A Certificate of Marriage. Any legal document issued by any governmental body that can be considered the unilateral equivalent to a marriage certificate or agreement.

Or any two of the following:

A revocable living will, trust, or other living trust agreement that names one another. A durable power of attorney or living will (naming each other). Proof of joint tenancy or documents that verify that the employee and partner have lived together previously for a period of at least Months months.

Proof of joint legal guardianship of a child or children. Joint utility bills or proof of other monthly expense(s). A printed invitation, announcement, or other proof of a "Commitment Ceremony" or other Ceremony in which commitment is affirmed to one another. Proof of life insurance documents or policies in which each partner is named as a beneficiary.

Joint bank or other financial account documentation. A recorded will bequeathing assets or personal belongings to one another. Proof of joint ownership of an automobile or vehicle. Proof of joint ownership of another piece of tangible property or asset.

Rights, Responsibilities, and Understanding Concerning This Statement of Domestic Partnership.

We, the undersigned, understand that the employee named below shall be obligated to file a Notice of Termination of Eligibility, available from the Human Resources Department, with the Company health plan administrator within 30 days of:

The date on which we no longer meet the above criteria for domestic partnership;. The date on which we become legally married;. The death of a Domestic Partner. We further understand that stating our Domestic Partnership and the acknowledgement of such by the Company may subject one or both of us to binding legal obligations to one another; including, but not limited to obligations to the Internal Revenue Service (IRS), State Tax obligations, or other taxing authorities and obligations.

We understand that Company Name is not offering legal advice or recommendations concerning such, and that we should consult an attorney to learn the extent of those obligations. We understand that the Company will keep this Statement of Domestic Partnership and all other enrollment forms private and confidential. These documents are to be used by the Company Human Resources Department in order to procure, provide, and otherwise administer benefits to its employees and their beneficiaries and to be further filed or used as required by law.

We hereby swear and affirm that the information provided in this agreement is true and accurate to the best of our knowledge, information, and belief. We understand that we shall be held liable for the information contained in this agreement and any benefits granted by the Company, its insurers, and all governing bodies due to obtaining Domestic Partner status. We represent that this Statement of Domestic Partnership was not obtained by coercion, duress, or by fraudulent means.

We agree to notify the Company Human Resources Department, in writing, of any changes to the status of this Domestic Partnership relationship or of any relevant information that may affect the eligibility to any benefits offered while employed at Company Name.

Employee Signature Date

Partner Signature Date

Human Resources Representative Date

The complete Statement of Domestic Partnership Form - with the actual formatting and layout - is available as a single template or as part of a library of related templates in a Contract Pack or the Professional Bundle.
Statement of Domestic Partnership Form
Product name:
Statement of Domestic Partnership Form
Produced by:
Proposal Kit
Software › Computer Software › Business & Productivity Software
$19 USD
Proposal Kit Reviews Logo4.7 stars, based on 843 reviews
Related documents may be used in conjunction with this document depending on your situation. Many related documents are intended for use as part of a contract management system.

Related Documents:

Key Takeaways

  • The Statement of Domestic Partnership Form is available as a ready-to-edit template.
  • The Contract Packs and Professional Bundle include many related agreements and documents.
  • You can automate financials and data merging into contracts using a Contract Pack or Professional Bundle.
  • You can also create business proposals and integrate your contracts using the Professional Bundle.
  • There are no ongoing subscription fees. You get lifetime unlimited use.

How to Build a Legal Contract with Proposal Kit

This video illustrates how to create a legal contract using the Proposal Pack Wizard software. It also shows how to create a proposal with an invoice and contract at the same time.

Proposal Kit LogoPublished by Proposal Kit, Inc.


Proposal Kit, Inc. makes no warranty and accepts no responsibility for the suitability of any materials to the licensee's business. Proposal Kit, Inc. assumes no responsibility or liability for errors or inaccuracies. Licensee accepts all responsibility for the results obtained. The information included is not legal advice. Names in use cases have been fictionalized. Your use of the Statement of Domestic Partnership Form template and any purchased packages constitutes acceptance and understanding of these disclaimers and terms and conditions.

© 1997 - 2024, Proposal Kit, Inc. All rights reserved. Privacy Policy.