Form 2—Parentage testing procedure AffidForm 2—Parentage testing procedure Affidavit by/in relation to donor

## Form 2—Parentage testing procedure Affidavit by/in relation to donor (subregulation 21F(1)) PARENTAGE TESTING PROCEDURE AFFIDAVIT BY/IN RELATION TO DONOR NAME OF CHILD WHOSE PARENTAGE IS IN ISSUE: (insert child’s name) NAME OF DONOR: (insert donor’s name) DATE OF BIRTH OF DONOR: (insert donor’s date of birth) \*RELATIONSHIP/\*PUTATIVE RELATIONSHIP OF DONOR TO CHILD WHOSE PARENTAGE IS IN ISSUE: (if donor is not the child whose parentage is in issue, insert relationship of donor to child) DATE OF TAKING SAMPLE FROM DONOR: (insert date sample is to be taken) I, (insert name), of (insert address), (insert occupation), \*make oath and say/\*affirm: | IMPORTANTEither Part 1 or 2 of this form must be completed and duly sworn or affirmed by the person completing it, and the signature witnessed, on the day the donor’s sample is taken. | | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | PART 1 | Part 1 must be completed if the person swearing or affirming the affidavit is the donor. | | ---------------------------------------------------------------------------------------- | 1. I am the person appearing in the photograph attached to this affidavit, being Attachment ‘A’. 2. My racial background is (insert details). 3. In the last 2 years: (a) I \*have/\*have not suffered from leukaemia; (b) I \*have/\*have not received a bone marrow transplant. \*4. The particulars of the \*leukaemia/\*bone marrow transplant are as follows: (insert particulars). 5. I \*have/\*have not received a transfusion of blood or a blood product within the last 6 months. \*6. The particulars of the transfusion of blood or blood product are as follows: (insert particulars). 7. I consent to: (a) the taking of \*a bodily sample/\*bodily samples from me on (insert date sample is to be taken) at (insert place sample is to be taken) for the purposes of \*a parentage testing procedure/\*parentage testing procedures; and (b) the carrying out of \*that procedure/\*those procedures on the \*sample/\*samples. PART 2 | Part 2 must be completed on behalf of a child or adult who is not capable of swearing or affirming the affidavit. Under subsection 69Z(2) of the Act, a parentage testing procedure must not be carried out in relation to a child without the consent of a parent or guardian of the child or a person who, under a specific issues order, is responsible for the child’s long‑term or day‑to‑day care, welfare and development. | | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | 1. I am the (state relationship or other status in relation to the donor) of (insert name of donor) who was born on (insert date of birth of donor). 2. (insert name of donor) is the person appearing in the photograph attached to this affidavit, being Attachment ‘A’. 3. (insert name of donor) is a person whose racial background is (insert details). 4. In the last 2 years: (a) the donor \*has/\*has not suffered from leukaemia; (b) the donor \*has/\*has not received a bone marrow transplant. \*5. The particulars of the \*leukaemia/\*bone marrow transplant are as follows: (insert particulars). 6. The donor \*has/\*has not received a transfusion of blood or a blood product within the last 6 months. \*7. The particulars of the transfusion of blood or blood product are as follows: (insert particulars). 8. I consent to: (a) the taking of \*a bodily sample/\*bodily samples from the donor on (insert date sample is to be taken) at (insert place sample is to be taken) for the purposes of \*a parentage testing procedure/\*parentage testing procedures; and (b) the carrying out of \*that procedure/\*those procedures on the \*sample/\*samples. \*SWORN/\*AFFIRMED by the deponent at on 20 (Signature of deponent) BEFORE ME: (insert name of person before whom the affidavit is sworn or affirmed) (Signature of person before whom affidavit is sworn or affirmed) Attach a recent photograph of the donor named in the affidavit, measuring approximately 45 millimetres by 35 millimetres, that shows a full face view of the donor’s head and the donor’s shoulders against a plain background. The photograph must be marked ‘A’, and must bear a statement, signed by both the person before whom the affidavit is sworn or affirmed and the deponent, identifying it as the photograph mentioned in the affidavit. \*Omit if not applicable.