Consent Orders Intake Form

    Who is making this application?

    Your details

    First Name

    Middle Name

    Family Name

    DOB

    Occupation

    Phone

    Email

    Your Residential Address

    Country

    Street

    Suburb/Town

    State

    Postcode

    Spouse's details

    First Name

    Middle Name

    Family Name

    DOB

    Occupation

    Phone

    Email

    Your Spouse's Residential Address

    Country

    Street

    Suburb/Town

    State

    Postcode

    Your Details

    Spouse's Details

    Do you regard Australia as your home?

    YesNo

    YesNo

    Have you lived in Australia for the last 12 months?

    YesNo

    YesNo

    Are you an Australian Citizen?

    YesNo

    YesNo

    Have you become an Australian citizen?

    YesNo

    YesNo

    Are you of Aboriginal and/or Torres Strait Islander origin?

    YesNo

    If so, which?

    YesNo

    If so, which?

    Are you married?

    YesNo

    YesNo

    If born overseas, in what country?

    Marriage

    Date of cohabitation
    (DD/MM/YYYY)

    Date of Marriage
    (DD/MM/YYYY)

    Date of Separation
    (DD/MM/YYYY)

    Place of Marriage

    Wife's Maiden Name

    Do you have any children under 18 years of age that are children of you and your spouse?

    YesNo

    Children's details

    Child 1

    First Name

    Middle Name

    Last Name

    Birthday

    Lives with:

    How is the child's health? (20-30 words)

    How is the child progressing at school/childcare(or preschoold)? (20-30 words)

    Which school do they attend? What year?

    What are the current contact arrangements? (20-30 words)

    Is there a child support arrangement? (20-30 words)

    Do you need to add another child?

    YesNo

    Child 2

    First Name

    Middle Name

    Last Name

    Birthday

    Lives with:

    How is the child's health? (20-30 words)

    How is the child progressing at school/childcare(or preschool)? (20-30 words)

    Which school do they attend? What year?

    What are the current contact arrangements? (20-30 words)

    Is there a child support arrangement? (20-30 words)

    Do you need to add another child?

    YesNo

    Child 3

    First Name

    Middle Name

    Last Name

    Birthday

    Lives with:

    How is the child's health? (20-30 words)

    How is the child progressing at school/childcare(or preschool)? (20-30 words)

    Which school do they attend? What year?

    What are the current contact arrangements? (20-30 words)

    Is there a child support arrangement? (20-30 words)

    Do you need to add another child?

    YesNo

    Child 4

    First Name

    Middle Name

    Last Name

    Birthday

    Lives with:

    How is the child's health? (20-30 words)

    How is the child progressing at school/childcare(or preschool)? (20-30 words)

    Which school do they attend? What year?

    What are the current contact arrangements? (20-30 words)

    Is there a child support arrangement? (20-30 words)

    Do you need to add another child?

    YesNo

    Child 5

    First Name

    Middle Name

    Last Name

    Birthday

    Lives with:

    How is the child's health? (20-30 words)

    How is the child progressing at school/childcare(or preschool)? (20-30 words)

    Which school do they attend? What year?

    What are the current contact arrangements? (20-30 words)

    Is there a child support arrangement? (20-30 words)

    Do you require a property settlement?

    YesNo

    Explain your agreement in basic language (500 words)

    Are there any pending cases in this or any other court about family law, child support, family violence or child welfare issues involving any of the parties or children listed in this application?

    YesNo

    If yes, describe

    Are there any existing orders, agreements, parenting plans or undertakings to a court about family law, child support, family violence or abuse in relation to a child (including orders which have applies to a child or a member of the child's family), or child welfare, concerning any of the parties or children listed in this application?

    YesNo

    If yes, describe

    Gross Annual Income

    You

    Your Partner

    Child Support: Applicant

    Are you paying child support?

    YesNo

    If yes, please provide details

    Amount paid per week

    Paid to (name)

    Are you receiving child support?

    YesNo

    If yes, please provide details

    Amount received each week

    Paid to you by (name)

    Child Support: Respondent

    Are they paying child support?

    YesNo

    If yes, please provide details

    Amount paid per week

    Is this number an estimate?

    YesNo

    Paid to (name)

    Are they receiving child support?

    YesNo

    If yes, please provide details

    Amount received each week

    Paid to you by (name)