Confidential Information Form3\Pg10a

Men's Rights Agency
CONFIDENTIAL INFORMATION - Page 3 of 3

CONFIDENTIAL INFORMATION To be completed and returned by Level 1 Applicants (Print or 'Save to File' and print later)

PROPERTY SETTLEMENT

Has a Property Settlement been completed......................... % share...........................................................................

Has a Consent Order for Property Settlement been registered with the Family Court.............................................

If none of the above has been completed, please detail property to be settled and if any offers have been made or accepted........................

......................................................................................................

MARITAL HOME DETAILS (Not your current home after separation)

Who is living in the family home................................................ Is the home owned or rented.....................................

Names on Title............................................................................... Home Loan (Yes or No).............................................

Who's paying the mortgage......................Current Equity $.................. Monthly Mortgage Payment $...................................

If you are not living in the RENTED family home, are you still paying the rent............. Monthly Rent $...............

Marital Home Address.......................................................... State.............................. P/C...................................

DOMESTIC VIOLENCE RESTRAINING ORDERS (Referred to as Apprehended Violence Orders in NSW)

Is a Domestic (Apprehended) Violence Order in place against you....................... or pending.................................

Court Date ................................... Court Location.............................

Have you applied for a DVO (AVO) against your ex partner......................................................................................

Court Date ................... Court Location..................................

Was your DV Application accepted.........................

Do you wish to apply for a DVO (AVO) against your ex partner...............................................................................

Please detail reasons briefly........................................................

.................................................................................................

................................................................................................

LEGAL AID ELIGIBILITY

Are you eligible for Legal Aid................ Have you applied.................. Has Legal Aid been granted......................

PREVIOUS SOLICITOR

Name & Address..........................................................................................................

Money spent to date $........................ Comments...........................................................................................................

PROBLEMS TO BE RESOLVED Detail issues causing concern - Attach additional information if necessary

................................................................................................................................................................................................

PERMISSION I give / do not give permission for MRA to hold this information on file. I understand the information is only used in the compilation of statistics and only forwarded to the designated solicitor, accountant, private investigator or counsellor. I believe I need to consult with the following:

Solicitor Accountant Private Investigator Counsellor CSA help

Signed................................................ Date.................................Signed for MRA.......................................................

Please complete all three sections and return with your Registration if you are a Level 1 applicant

Either download, print and complete form, then return by mail to MRA, P.O. Box 28, Waterford Qld 4133

or Fax to (07) 3805 5611 or complete on screen after download and E-mail to mra@ecn.net.au

Return to Page 1 of the Confidential Information
Return to Children's details Pg2
Return to Registration Application Form
Return to Registration Information

To: mra@ecn.net.au

or write to P.O. Box 28, Waterford Qld 4133 Australia
Fax: (07) 3200 8769
Tel: (07) 3805 5611

Men's Rights Agency P/L ACN 063 925 566
A non-profit organisation helping men and their families