Statement of arrangements for children




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FORM M4

Rule 2.3(2)

STATEMENT OF ARRANGEMENTS FOR CHILDREN



IN THE COUNTY COURT FOR THE DIVISION OF      

Between


     

Petitioner

and

     


Respondent

and


     

Co-Respondent




To the Petitioner

You must complete this form if you or the respondent have any children



  • under 16; or

Please complete Parts I, II and III.

Before you issue a petition for divorce try to reach agreement with your husband/wife over the proposals for the children’s future. There is space for him/her to sign at the end of this form if agreement is reached.

If your husband/wife does not agree with the proposals he/she will have the opportunity at a later stage to state why he/she does not agree and will be able to make his/her own proposals.

You should take or send the completed form, signed by you (and, if agreement is reached, by your husband/wife) together with a copy to the court when you issue your petition

If you wish to apply for any f the orders which may be available to you under Part II or III of the Children (Northern Ireland) Order 1995 you are advised to see a solicitor.

The court will only make an order if it considers that an order will be better for the child(ren) than no order.

You should obtain legal advice from a solicitor or, alternatively, from an advice agency. Addresses of solicitors and advice agencies can be obtained from the Yellow Pages.


To the Respondent

The petitioner has completed Part I, II and III of this form which will be sent to the court at the same time that the divorce petition is filed.

Please read all parts of the form carefully

If you agree with the arrangements and proposals for the children you should sign Part IV of the form

You should return the form to the petitioner, or his/her solicitor.

If you do not agree with all or some of the arrangements or proposals you will be given the opportunity of saying so when the divorce petition is served on you.






Part 1 – Details of the children
Please read the instructions for boxes 1, 2 and 3 before you complete this section




  1. Children of both parties (Give details only of any children born to you and the Respondent or adopted by you both)




Forenames

Surname

Date of Birth

















































  1. Other children of the family (Give details of any children treated by both of you as children of the family; for example your own or the Respondents)




Forenames

Surname

Date of Birth

Relationship to

Yourself

Respondent















































































  1. Other children who are not children of the family (Give details of any children born to you or the Respondent that have not been treated as children of the family or adopted by you both)




Forenames

Surname

Date of Birth














































Part II – Arrangements for the children of the family
This part of the form must be completed. Give details for each child if arrangements are different. If necessary, continue on another sheet and attach it to this form.


4. Home details (Please tick the appropriate boxes)


(a) The address at which the children now live




(b) Give details of the number of living rooms, bedrooms, etc at the address in (a)




(c) Is the house rented or owned and by whom?





Is the rent or any mortgage being regularly paid?




No




Yes

(d) Give the names of all other persons living with the children including your husband/wife if he/she lives there. State their relationship to the children




(e) Will there be any change in these arrangements?




No




Yes

(Please give details)







  1. Education and training details (Please tick the appropriate boxes)




(a) Give the names of the school, college or place of training attended by each child.




(b) Do the children have any special educational needs?




No




Yes

(Please give details)




(c) Is the school, college or place of training, fee-paying




No




Yes

(Please give details of how much the fees are per term/year)




Are fees being regularly paid?




No




Yes

(Please give details)




(d) Will there be any change in these arrangements?




No




Yes

(Please give details)




6. Childcare details (Please tick the appropriate boxes)


(a) Which parent looks after the children from day to day? If responsibility is shared, please give details




(b) Does that parent go out to work?




No




Yes

(Please give details of his/her hours of work)




(c ) Does someone look after the children when the parent is not there?




No




Yes

(Please give details)




(d) Who looks after the children during school holidays?




(e) Will there be any change in these arrangements?




No




Yes

(Please give details)





7. Maintenance (Please tick the appropriate boxes)


(a) Does your husband/wife pay towards the upkeep of the children? If there is another source of maintenance please specify.




No




Yes

(Please give details of how much)




(b) Is the payment made under a court order?




No




Yes

(Please give details)




(c) Is the payment following an assessment by the Child Support Agency




No




Yes

(Please give details)




(d) Has maintenance for the children been agreed?




No




Yes

If not, will you be applying for a maintenance order from the court?




No




Yes

Child support maintenance through the Child Support Agency?




No




Yes

8. Details for contact with the children (Please tick the appropriate boxes)


(a) Do the children see your husband/wife?




No




Yes

(Please give details of how often and where)




(b) Do the children ever stay with your husband/wife?




No




Yes

(Please give details of how much)




(c) Will there be any changes to these arrangements?




No




Yes

(Please give details of how much)





9. Details of health (Please tick the appropriate boxes)


(a) Are the children generally in good health?




No




Yes







(b) Do the children have any special needs?




No




Yes







10. Details of care and other court proceedings (Please tick appropriate boxes)


(a) Are the children in the care of a local authority, or under the supervision of a social worker or probation officer?




No




Yes

(Please give details including any court proceedings)




(b) Are any of the children on the Child Protection Register?




No




Yes

(Please give details of the local authority and the date of registration)




(c) Are there or have there been any proceedings in any court involving the children, for example adoption, custody/residence, access/contact wardship, care, supervision or maintenance (you need not include any Child Support Agency proceedings)?




No




Yes

(Please give details and send a copy of any order the court)







Part III – To the Petitioner
Conciliation

If you and your husband/wife do not agree about the arrangements for the child(ren), would you agree to discuss the matter with a Conciliator and your husband/wife?







No




Yes

Declaration


I declare that the information I have given is correct and complete to the best of my knowledge.
Signed ……………………………………………………………(Petitioner)
Date: ……………………………………………………………..




Part IV – To the Respondent

I agree with the arrangements and proposals contained in Part I and II of this form.


Signed: …………………………………………………….. (Respondent)
Date: ………………………………………………………

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