Confidential information

Published date21 March 2018
Subject MatterAdoption forms
Condential information
• This form is for use if you are a party in proceedings under the Adoption and Children Act 2002, and you
want the court to keep certain details about you or the child condential.
• Before lling in this form, please read carefully the guidance notes on completion.
• Please use black ink when lling in the form.
A65 Condential information (12.05) HMCS
Name of court
Case no./Serial no.
Date received by the court
Part 1 Your name and the name of the child
First applicant/respondent
My name is
First name(s) in full
Last name
Second applicant/respondent
My name is
First name(s) in full
Last name
Mr Mrs Miss
Ms Other
Mr Mrs Miss
Ms Other
Child’s name
First name(s) in full Last name
Part 2 Information to be kept condential
Your address and telephone number
My telephone number isMy address is (including postcode)
If you want your private address and telephone number to be kept condential, please
complete the details below:
1 of 2
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