[Company Name] acknowledges the need for inclusion and fairness in providing benefits to our employees. Therefore, domestic partners will receive the same benefits that are available to spouses of company employees (e.g., [insert applicable benefits, such as medical insurance, dental insurance, beneficiary designations on retirement plans, family and medical leave, sick leave, and bereavement leave]).
Domestic partners are those individuals who meet the following criteria:
- At least 18 years old and mentally competent to consent to a contract.
- Not legally married to anyone.
- Not related by blood to a degree of closeness that would prohibit legal marriage in [the state of ___________].
- Have entered into the domestic partner relationship voluntarily and without reservation.
- Are jointly responsible for each other's common welfare and shared financial obligations.
- Intend to continue the domestic partner relationship indefinitely, with the understanding that the relationship can be terminated at any time by either partner.
Procedure
Employees who wish to apply for domestic partner benefits must complete a statement of domestic partnership. The original form will be kept in the human resources department. The employee and the domestic partner will both be furnished a copy of the statement of domestic partnership for their records.
This original form will be kept on file indefinitely with human resources and will be deemed effective until one of the following occurs:
- The employee changes the partner designation by completing a new statement of domestic partnership and returns the new form to human resources.
- The employee requests removal of the document and completes a statement of termination of domestic partnership. Benefits coverage for domestic partners and their dependents will terminate at the end of the month in which the relationship ended.
Taxation
The fair market value of benefits for domestic partners is required by the Internal Revenue Service to be reported as taxable income to the employee.
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