The term “domestic partner” in a contract or rider to a contract shall include individuals of the same and the opposite sex. If an individual makes an application to include a domestic partner or a child dependent of a domestic partner as a dependent under a contract, the carrier may require the individual to submit not more than the following as proof of the domestic partner relationship: The affidavit described in §C of this regulation; Proof that the individual meets one criteria from §D of this regulation; and Proof that the individual meets one criteria from §E of this regulation. Affidavit Attesting to Domestic Partnership. An affidavit signed by both the insured and the domestic partner shall include only the following attestations: Both individuals are 18 years old or older; Neither individual is related to the other by blood or marriage within four degrees of consanguinity under civil law rule; Neither individual is married or in a civil union or domestic partnership with another individual; Both individuals have been financially interdependent for at least 6 consecutive months prior to application in which each individual contributes to some extent to the other individual's maintenance and support with the intention of remaining in the relationship indefinitely; and Both individuals share a common primary residence. Carriers may develop their own affidavits or may use the affidavit set forth in §C(3) of this regulation. The following is a sample affidavit that complies with the requirements of §B(1) of this regulation:AFFIDAVIT OF DOMESTIC PARTNERSHIP Instructions: In order to enroll your Domestic Partner for medical benefits, you and your Domestic Partner must sign this Affidavit of Domestic Partnership. Please carefully read this Affidavit and the information below. Both you and your Domestic Partner must certify that you are Domestic Partners by completing and signing below. I, {Name of Subscriber} and {Name of Partner} certify that we are Domestic Partners and that we: Are at least 18 years old; Are not related to the other by blood or marriage within four degrees of consanguinity under civil law rule; Are not married or in a civil union or domestic partnership with another individual; Have been financially interdependent for at least 6 consecutive months prior to application in which each individual contributes to some extent to the other individual's maintenance and support with the intention of remaining in the relationship indefinitely; and Share a common primary residence. We understand that a civil action may be brought against us for losses, including reasonable attorney fees and court costs, because of willful falsification of information in this Affidavit of Domestic Partnership. We understand that willful falsification of information contained in this Affidavit may result in our termination of enrollment. We certify under penalty of perjury under applicable state laws, that the foregoing is true and accurate to the best of our knowledge. _________________________________________________________________________ Signature of Subscriber Date _________________________________________________________________________ Signature of Domestic Partner Date The carrier shall accept any one of the following documents as proof of a common primary residence between domestic partners: Common ownership of the primary residence via joint deed or mortgage agreement; Common leasehold interest in the primary residence; Driver's license or State-issued identification listing a common address; or Utility or other household bill with both the name of the insured and the name of the domestic partner appearing. The carrier shall accept any one of the following documents as proof of financial interdependence between domestic partners: Joint bank account or credit account; Designation as the primary beneficiary for life insurance or retirement benefits of the domestic partner; Designation as primary beneficiary under the domestic partner's will; Mutual assignments of valid durable powers of attorney under Estates and Trusts Article, §13-601, Annotated Code of Maryland; Mutual valid written advanced directives under Health-General Article, §5-601 et seq., Annotated Code of Maryland, approving the other domestic partner as health care agent; Joint ownership or holding of investments; or Joint ownership or lease of a motor vehicle. A carrier may require a group policyholder to obtain the documents specified under this chapter prior to enrolling a domestic partner or a child dependent of a domestic partner.