Subject to the definition of "spouse or common-law partner", this declaration will serve to designate an individual as a common-law partner for purposes of the Foreign Service Directives and for the relevant benefits to be accorded thereunder.
We, _________________________ and _________________________ solemnly declare that our relationship is and has been demonstrated by our cohabitation in a conjugal relationship. This relationship is and has been recognized for a period of at least one year in the community or communities in which we have lived.***
Where these conditions cease to exist, we acknowledge the right of the deputy head to cease payments made on the basis of the existence of such conditions.
Where these conditions do not in fact exist, we acknowledge the right of the deputy head to recover the amounts of money paid on the basis of the existence of such conditions.
*** In specific cases, this declaration may be used where there has been a break in the period of cohabitation for reasons beyond the control of the employee or the individual to be designated as common-law partner. See Appendix B of this directive.
Signed _____________________________ Employee
___________________________________ Common-law partner
___________________________________ Date
Signed _____________________________ for the deputy head
___________________________________ Date