Name of child whose parentage is in issue: ............................................................
Part 1
1 I, [name of nominated reporter], of [laboratory address], am a person nominated by the laboratory specified below to prepare a report in accordance with the Status of Children Regulation 2026, section 6.
2 I report that a parentage testing *procedure/*procedures, being DNA profiling,
*has/*have been carried out on the bodily *sample/*samples contained in the sealed *container/*containers bearing the *name/names of the following *donor/*donors—
(a) [donor’s name, date of birth and relationship to the child whose parentage is in issue],
*(b) [donor’s name, date of birth and relationship to the child whose parentage is in issue],
*(c) [donor’s name, date of birth and relationship to the child whose parentage is in issue],
*(d) [donor’s name, date of birth and relationship to the child whose parentage is in issue].
3 Each bodily sample referred to in item 2 is the same bodily sample as the bodily sample specified in the statement completed on [date] by [name of sampler] in accordance with the Status of Children Regulation 2026, section 12.
4 The parentage testing *procedure was/*procedures were carried out at [name of laboratory or laboratories].
5 The results of the parentage testing *procedure/*procedures are set out in Part 2 of this report.
*6 I report that the results of the parentage testing *procedure/*procedures carried out on the bodily *sample/*samples of the donors specified above show that [name of putative parent] is not excluded from identification as the *father/*mother of [name of child whose parentage is in issue].
Schedule Schedule 1 - Status of Children Regulation 2026 - Forms | Zoe
[OR]
*6 I report that the results of the parentage testing *procedure/*procedures carried out on the bodily *sample/*samples of the donors specified above show that [name of putative parent] is excluded from identification as the *father/*mother of [name of child whose parentage is in issue].
*7 I further report that the probability that [name of putative parent] is the genetic *father/*mother of [name of child whose parentage is in issue] has been calculated as follows—
| *Paternity/*Maternity Index | [figure] |
| Relative chance of *Paternity/*Maternity | [percentage] |
[OR]
*7 I further report that the exclusion is based on contradictions to the laws of genetic inheritance in [amount] of the [amount] genetic markers tested. The contradictions occurred in the following genetic markers: [names of genetic markers]
*8 I further report [if necessary, provide further explanation of results detailed in items 6 and 7].
Dated 20 .
.........................
[Signature of nominated reporter]
Part 2
1 The bodily *sample/*samples referred to in Part 1 *was/*were received at [name of laboratory at which the parentage testing *procedure was/*procedures were carried out] on 20 .
2 The following identification numbers were allocated respectively to the bodily *sample/*samples in the *container/*containers in which the *procedure was/*procedures were carried out—
(a) [name of person and identification number],
*(b) [name of person and identification number],
*(c) [name of person and identification number],
*(d) [name of person and identification number].
3 The results obtained from the parentage testing *procedure/*procedures are as follows: [set out the results]
4 The results set out in item 3 refer to the parentage testing *procedure/*procedures carried out *by me/*under my supervision on [date]. The bodily *sample was/*samples were tested with the same primers and in parallel with appropriate known controls. Fragment length pattern was in accordance with scientifically accepted standards. I am satisfied that the results obtained have been correctly coded from the fragment pattern and that they have been correctly transcribed from the laboratory records.
Dated 20 .
.........................
[Signature of person who carried out parentage testing procedure or person under whose supervision procedure was carried out]
*Delete if not applicable.
Form 2 Parentage testing procedure affidavit by or in relation to donor
section 9(2), definition of “duly completed affidavit”
Name of child whose parentage is in issue: ............................................................
Name of donor: ............................................................
Date of birth of donor: ............................................................
*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: ............................................................
I, [name], of [address], [occupation] *make oath and say/*affirm—
Note—
Either Part 1 or Part 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
This part 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: [give details]
3 In the last 2 years—
(a) I *have/*have not suffered from leukaemia, and
(b) I *have/*have not received a bone marrow transplant.
*4 The particulars of the *leukaemia/*bone marrow transplant are as follows: [give 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: [give 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 *the procedure/*procedures on the *sample/*samples.
Part 2
This part must be completed by the donor’s representative for a child or adult who is not capable of swearing or affirming the affidavit. Under the Act, section 28, 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.
1 I am the [state relationship or other status in relation to the donor] of [name of donor] who was born on [date of birth of donor].
2 [Name of donor] is the person appearing in the photograph attached to this affidavit, being Attachment ‘A’.
3 [Name of donor] is a person whose racial background is: [give details]
4 In the last 2 years—
(a) the donor *has/*has not suffered from leukaemia, and
(b) the donor *has/*has not received a bone marrow transplant.
*5 The particulars of the *leukaemia/*bone marrow transplant are as follows: [give 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: [give 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 *the procedure/*procedures on the *sample/*samples.
*SWORN/*AFFIRMED by the
deponent at
on 20 .
.........................[Signature of deponent]
Before me—
.........................[Signature of person before whom the affidavit is sworn or affirmed]
Attach a photograph of the donor named in the affidavit that complies with the requirements of section 9(2), definition of complying photograph of the donor. 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.
I [insert name of witness], a [insert qualification to be witness], certify the following matters concerning the making of this affidavit by the person who made it—
1 *I saw the face of the person or *I did not see the face of the person because the person was wearing a face covering, but I am satisfied that the person had a special justification for not removing the covering.
2 *I have known the person for at least 12 months or *I have confirmed the person’s identity using an identification document and the document I relied on was [describe identification document relied on].
[insert signature of witness]
Dated 20 .
Form 3 Parentage testing procedure collection of bodily sample statement by sampler
Name of child whose parentage is in issue: ............................................................
1 I, [name of sampler], of [professional address], [occupation], took the bodily *sample/*samples specified below at [time] *am/*pm on [date] at [place of collection] from the following *person/*persons—
(a) [name of person and type of bodily sample stated and person’s photograph affixed],
*(b) [name of person and type of bodily sample stated and person’s photograph affixed],
*(c) [name of person and type of bodily sample stated and person’s photograph affixed],
*(d) [name of person and type of bodily sample stated and person’s photograph affixed].
2 When I took the bodily *sample/*samples specified above, I strictly observed the procedures provided under the Status of Children Regulation 2026.
3 I placed *the bodily sample/*each of the bodily samples specified above in a container that was immediately sealed and then labelled in accordance with the Status of Children Regulation 2026, section 12.
SIGNATURES MUST BE WITNESSED BY AN AUSTRALIAN LEGAL PRACTITIONER.
IF A PARTY IS UNAVAILABLE TO SIGN THIS FORM, THE LAST KNOWN ADDRESS OF THE PERSON SHOULD BE PROVIDED IN THE APPROPRIATE SECTION IMMEDIATELY BELOW.
| I .........................[full name of mother] | I .........................[full name of father] |
| of .................................................. | of .................................................. |
| Postcode: ..... Phone: .......... | Postcode: ..... Phone: .......... |
hereby acknowledge that we are the biological mother and father of the child named below. We request that the Registrar include details of the father, as stated below, on the birth record of the child.
CHILD’S PARTICULARS
| ................................... | Sex: .......... |
| [given names] | [family name] | |
| born on ../../.. | at ...................., New South Wales. |
FATHER’S PARTICULARS (at time of child’s birth)
| ................................... | Occupation: .......... |
| [given names] | [family name] | |
| born on ../../.. | at .............................. |
This acknowledgment is made believing that the information provided is true to the best of our knowledge and belief.
| .........................[mother’s signature] | .........................[father’s signature] |
| Signed at .................... | Signed at .................... |
| on ......................... | on ......................... |
| Witnessed by ............... | Witnessed by ............... |
| Qualification ............... | Qualification ............... |
| [Legal practitioner]......................... | [Legal practitioner]......................... |
| [name, address and telephone no. of witness]......................... | [name, address and telephone no. of witness]......................... |