Men's Rights Agency
CONFIDENTIAL INFORMATION - Page 2 of 3

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

CHILDREN OF THE RELATIONSHIP AND RESIDENCY

	Age	Date of Birth	<<<FirstNames>>>	Relationship to child i.e. Natural/ Step/Adopted of:		Children
						Live with		Since (Date)
				Mother	Father	Mother	Father
1		__/__/__
2		__/__/__
3		__/__/__
4		__/__/__
5		__/__/__

Do you have a liability to maintain other children from a previous relationship............................................

Do you pay maintenance through CSA ...................... How much $......................per week/month/year    

Do you require assistance with CSA Assessment or Reviews..................................................................

YOUR CURRENT STATUS

Are you in a new relationship

Yes/No

Married

.......

Defacto

......

Are you the natural parent of any children from this relationship. Please list below

	Age	Date of Birth	First Names
1
2

RESIDENCY & CONTACT ARRANGEMENTS

Who has "Residency" of your children.................................................

Describe "Contact" arrangements.......................................................

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

Are Consent Orders signed..................... Are the Consent Orders

registered with the Family Court.................... 

continue to Property/asset details etc Pg 3
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Men's Rights Agency P/L ACN 063 925 566
A non-profit organisation helping men and their families

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