Form 3—Application for orderForm 3—Application for order

Form 3—Application for order

(insert heading for document in accordance with Form 1)

Application for order under section 111CN*/section 111CW*/ regulation 15*/the Convention* in a State court

1 Identity of child, parents, applicant(s)

1.1 Child

(insert the following details, if known, relating to the child)

Surname:

Forename/(s):

Sex:

Age:

Date and place of birth:

Father’s surname:

Forename/(s):

Mother’s maiden surname:

Forename/(s):

1.2 Applicant(s)

(insert the following details relating to the parents and applicant/(s) (if not a parent))

Mother

Surname:

Forename/(s):

Occupation:

Address:

Father

Surname:

Forename/(s):

Occupation:

Address:

Guardian (or other applicant)

Surname:

Forename/(s):

Occupation:

Address:

2 Order sought

Under regulation 15 of the Family Law (Child Protection Convention) Regulations 2003, application is made for the following order:

(insert description of order sought)

3 Attachments to application

The following documents are attached:

(insert description of documents attached)

4 Any other matters in relation to application

Under regulation 15 of the Family Law (Child Protection Convention) Regulations 2003, application is made for the following further order:

(insert details or attach statement containing details)

DATED (insert date)

(signature)

Signature(s) of applicant(s)

(insert title/position of State central authority)

If the applicant is a State central authority—the title or position of the authority.

Affidavit

(insert affidavit—Form 2)

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* omit if inapplicable