| THE HIGH COURT | ||||
| FAMILY LAW | ||||
| [Insert as appropriate] | ||||
| IN THE MATTER OF THE JUDICIAL SEPARATION AND FAMILY LAW REFORM ACT 1989 | ||||
| IN THE MATTER OF THE FAMILY LAW ACT 1995 | ||||
| IN THE MATTER OF THE FAMILY LAW (DIVORCE) ACT 1996 | ||||
| BETWEEN/ | ||||
| A.B. | ||||
| Applicant | ||||
| and | ||||
| C.D. | ||||
| Respondent |
| AFFIDAVIT OF WELFARE | ||
| I, …………………….., ………………………. [insert occupation], of ……………………………., aged 18 years and upwards MAKE OATH and say as follows:— | ||
| 1. | I say that I am the Applicant/Respondent [Delete as appropriate] in above entitled proceedings and I make this Affidavit from facts within my own know- ledge save where otherwise appears and where so appearing I believe the same to be true. | |
| 2. | I say and believe that the facts set out in the Schedule hereto are true. | |
| [In circumstances in which the Respondent does not dispute the facts deposed to by the Applicant in his/her Affidavit of Welfare, the following averment shall be included, replacing paragraph 2 hereof, and in such circumstances, the Schedule shall not be completed by the Respondent: | ||
| 2. | I say that I am fully in agreement with the facts as averted to by the Applicant in his/her Affidavit of Welfare sworn herein on the……………………………….. day of……………………………….. 20……. and I say and believe that the facts set out in the Schedule hereto are true]. | |
| SCHEDULE | ||
| Part I — Details of the children | ||
| 1. | Details of children born to the Applicant and the Respondent or adopted by both the Applicant and the Respondent. | |
| Forenames …………………… Surname …………………… Date of Birth …………………. | ||
| 2. | Details of other children of the family or to which the parents or either of them are in loco parentis | |
| Forenames ………………….. Surname ………………….. Date of Birth ………………….. | ||
| Relationship to | ||
| Applicant/Respondent | ||
| Part II — Arrangements for the children of the family | ||
| 3. | Home details | |
| (a) | The address or addresses at which the children now live. | |
| (b) | Give details of the number of living rooms, bedrooms, etc., at the addresses in (a) above. | |
| (c) | Is the house rented or owned and, if so, name the tenant(s) or owner(s). | |
| (d) | Is the rent or mortgage being regularly paid and, if so, by whom- | |
| (e) | Give the name of all other persons living with the children either on a full-time or part time basis and state their relationship to the children, if any. | |
| (f) | Will there be any change in these arrangements and, if so give details. | |
| Part III — Education and training details | ||
| (a) | Give the names of the school, college or place of training attended by each child. | |
| (b) | Do the children have any special educational needs. If so, please specify. | |
| (c) | Is the school, college or place of training fee-paying. If so, give details of how much the fees are per term/year. Are fees regularly paid and, if so, by whom- | |
| (d) | Will there be any change in these circumstances- If so, give details. | |
| Part IV — Childcare details | ||
| (a) | Which parent looks after the children from day to day- If responsibility is shared, please give details. | |
| (b) | Give details of work commitments of both parents. | |
| (c) | Does someone look after the children when the parent is not there- If yes, give details. | |
| (d) | Who looks after the children during school holidays- | |
| (e) | Will there be any change in these arrangements- If yes, give details. | |
| Part V — Maintenance | ||
| (a) | Does the Applicant/Respondent pay towards the upkeep of the children- If yes, give details. Please specify any other source of maintenance. | |
| (b) | Is the maintenance referred to at (a) above paid under court order- If yes, give details. | |
| (c) | Has maintenance for the children been agreed- If yes, give details. | |
| (d) | If not, will you be applying for a maintenance order from the Court- | |
| Part VI — Details of contact with the children | ||
| (a) | Do the children see the Applicant/Respondent- Please give details. | |
| (b) | Do the children stay overnight and/or have holiday visits with the Applicant/Respondent- Please give details. | |
| (c) | Will there be any change to these arrangements- Please give details. | |
| Part VII — Details of health | ||
| (a) | Are the children generally in good health- Please give details of any serious disability of chronic illness suffered by any of the children. | |
| (b) | Do the children or any of them have any special health needs- Please give details of the care needed and how it is to be provided. | |
| (c) | Are the Applicant or Respondent generally in good health- If not, please give details. | |
| Part VIII — Details of care and other court proceedings | ||
| (a) | Are the children or any of them in the care of a health board or under the supervision of a social worker or probation officer- If so, please specify. | |
| (b) | Are there or have there been any proceedings in any Court involving the children or any of them- If so, please specify. (All relevant court orders relating to the children or any of them should be annexed hereto). | |
| Part IX — Declaration | ||
| I, ……………………………………………… , Applicant/Respondent [delete as appropriate], declare that the information I have given herein is correct and complete to the best of my knowledge. | ||
| Signed: ……………………………………………… | ||
| Applicant/Respondent | ||
| Witnessed: ……………………………………………… | ||
| Date: ……………………………………………… | ||
| Part X — Agreement of Respondent (where applicable) | ||
| I, ……………………………………………… , Respondent, declare that the information given by the Applicant herein is correct and complete to the best of my know- ledge and I agree with the arrangements and proposals contained herein. | ||
| Signed: ……………………………………………… | ||
| Respondent | ||
| Witnessed: ……………………………………………… | ||
| Date: ……………………………………………… | ||
