Annex C - Application for establishment of a decision
| Published date | 21 March 2018 |
| Subject Matter | Family law forms |
Application for Establishment of a Decision
(including where necessary the establishment of parentage)
( Article 10(1) c) Article 10(1) d))
CONFIDENTIALITY AND PERSONAL DATA PROTECTION NOTICE
Personal data gathered or transmitted under the Convention shall be used only for the purposes for which it was gathered or transmitted. Any authority processing such information shall ensure its confidentiality, in accordance with the law of its State.
An authority shall not disclose or confirm information gathered or transmitted in application of this Convention if it determines that to do so could jeopardise the health, safety or liberty of a person in accordance with Article 40.
A determination of non-disclosure has been made by a Central Authority in accordance with Article 40. If this box is ticked, information under sections 2 d, e, f and g and 5 should only be provided in the Restricted Information on the Applicant page of this form.
1. Requesting Central Authority file reference number: _________________________
2. Particulars of the applicant
a. Family name(s): _________________________________________________
b. Given name(s): _________________________________________________
c. Date of birth: _____________________________________ (dd/mm/yyyy)
d. Address: _________________________________________________
_________________________________________________
e. Telephone numbers: _________________________________________________
_________________________________________________
f. Fax number: _________________________________________________
g. E-mail: _________________________________________________
3. Particulars of the person(s) for whom maintenance is sought or payable
3.1 Maintenance is sought or payable for the applicant named above
Parentage is established or presumed
Maintenance basis:
parentage in loco parentis or equivalent relationship
marriage analogous relationship to marriage
affinity (please identify): _________________________________
grandparent sibling grandchild
other: ________________________________________________
3.2 Maintenance is sought or payable for the following child(ren)
a. Family name(s): _____________________________________
Given name(s): _____________________________________
Date of birth: ________________________________ (dd/mm/yyyy)
Parentage is established or presumed
Maintenance basis:
parentage in loco parentis or equivalent relationship
b. Family name(s): _____________________________________
Given name(s): _____________________________________
Date of birth: ________________________________ (dd/mm/yyyy)
Parentage is established or presumed
Maintenance basis:
parentage in loco parentis or equivalent relationship
c. Family name(s): _____________________________________
Given name(s): _____________________________________
Date of birth: ________________________________ (dd/mm/yyyy)
Parentage is established or presumed
Maintenance basis:
parentage in loco parentis or equivalent relationship
3.3 Maintenance is sought or payable for the following person
Family name(s): _____________________________________
Given name(s): _____________________________________
Date of birth: ________________________________ (dd/mm/yyyy)
Maintenance basis:
marriage analogous relationship to marriage
affinity (please identify): _________________________________
grandparent sibling grandchild
other: ________________________________________________
3.4 Maintenance is sought or payable for additional children or persons, additional particulars are attached
4. Particulars (if known) of the debtor (respondent)
a. Family name(s): ____________________________________
b. Given name(s): ____________________________________
c. Date of birth: ________________________________ (dd/mm/yyyy)
d. Personal identification number: _______________________
(include name of country or territorial unit that issued the number)
e. Residential address: ____________________________________
____________________________________
f. Postal address: ____________________________________
____________________________________
g. Any other information that may assist with the location of the debtor
________________________________________________________
________________________________________________________
5. Payments
a. Details for electronic transfer of payments (if applicable)
Name of the bank: ________________________________
NBIC:[1] ________________________________
SWIFT-address: ________________________________
IBAN: [2] ________________________________
Account number: ________________________________
Name of account holder: ________________________________
Reference: [3] ________________________________
b. Details for payments by cheques (if applicable)
Cheque payable to: ________________________________
Cheque to be sent to: ________________________________
(address) ________________________________
________________________________
Reference:3 ________________________________
6. This application is for the establishment of a decision in the requested State where:
a. there is no existing decision (Article 10(1) c))
b. recognition and enforcement of a decision is not possible or is refused because of the lack of a basis for recognition and enforcement under Article 20 or on the grounds specified in Article 22 b) or e) (Article 10(1) d))
7. Support / maintenance sought by the applicant [4] (specify currency[5] for each amount)
Support / maintenance
Please specify the amount: _________________________________________
Frequency of payments
week two weeks month 3 months 6 months
year other (specify): _______________________
Retroactive support / maintenance
Please specify date from which retroactive maintenance is sought:
_____________ (dd/mm/yyyy)
Please specify the amount: _________________________________________
Frequency of payments
week two weeks month 3 months 6 months
year single payment other (specify): ________________
Other payments, arrangements or conditions
Please specify: _______________________________________________
Please specify the amount: __________________________________
Frequency of payments
week two weeks month 3 months 6 months
year other (specify): _______________________
8. The following document(s) are attached in support of this application:
Birth certificate or equivalent
Acknowledgement of parentage by the debtor
Formal statement providing evidence relating to parentage
Decision of competent authority concerning parentage
Genetic test results
Adoption certificate
Certificate of marriage or similar relationship and date of divorce / separation
Formal statement providing evidence relating to common residence of the parties
Agreement between the parties relating to maintenance
Evidence of attendance at secondary or post-secondary educational institution
Evidence of disability
Financial Circumstances Form
Statement of arrears or payment history
Other evidence in accordance with the law of the requested State
Decision of the requested State refusing recognition and enforcement
9. Please initiate enforcement measures once the decision is established
10. Other information: ________________________________________________
_________________________________________________________________
11. Attestations
This application was completed by the applicant and reviewed by the requesting Central Authority
This application complies with the requirement of the Convention (Article 12(2)). The information contained in this application and the attached documents correspond to and are in...
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