Circuit Court Forms

FORM 37B
 

AN CHÚIRT TEAGHLAIGH CHUARDA
THE CIRCUIT FAMILY COURT

                               CIRCUIT                                                                               COUNTY OF
 

IN THE MATTER OF THE JUDICIAL SEPARATION AND FAMILY LAW REFORM ACT, 1989 AND IN THE MATTER OF THE FAMILY LAW ACT, 1995

OR

IN THE MATTER OF THE FAMILY LAW (DIVORCE) ACT, 1996
AND IN THE MATTER OF AN INTENDED ACTION (if appropriate)

BETWEEN

………………. Applicant
AND
…………………. Respondent

AFFIDAVIT OF WELFARE

I, [Insert name of Deponent], ....................... [Insert occupation of Deponent], ...................... of [Insert address of Deponent] .............. being aged 18 years and upwards MAKE OATH and say as follows:
 

1. I say that I am the Plaintiff/Defendant [delete as appropriate] in the above entitled proceedings and I make this Affidavit from facts within my own knowledge save where otherwise appears and where so appearing I believe the same to be true.
 

2. I say and believe that the facts set out in the Schedule hereto are true.
[In circumstances in which the Defendant does not dispute the facts as deposed to by the Plaintiff in his/her Affidavit of Welfare, the following averment shall be included, replacing Paragraph 2 hereof, and in such circumstances, the Schedule shall not be completed by the Defendant:
 

2. I say that I am fully in agreement with the facts as averred to by the Plaintiff in his/her Affidavit of Welfare sworn herein on the day of and I say and believe that the facts set out in the Schedule thereto are true.]

SCHEDULE

Part I -- Details of Children

1. Details of children born to the Plaintiff and the Defendant or adopted by both the Plaintiff and the Defendant:
Forenames .....
Surname .....
Date of Birth .....
2. Details of other children of the family or to which the parties or either of them are in loco parentis
Forenames .....
Surname ......
Date of Birth ......
Relationship to Plaintiff/Defendant ......

Part II -- Arrangements for the children of the family

1. Home Details:
(a) The address or addresses at which the children now live
(b) Give details of number of living rooms, bedrooms etc. at the address(es) in (a) above
(c) Is the house rented or owned and, if so, name the tenant(s) or owner(s)?
(d) Is the rent or mortgage being regularly paid and, if so, by whom?
(e) Give names of all other persons living with the children either on a full-time or part-time basis and state their relationship to the children, if any.
(f) Will there be any change in these arrangements and, if so, give details.

Part III -- Education and training details

(a) Give names of the school, college or place of training attended by each child.
(b) Do the children have any special education needs? If so, please specify.
(c) Is the school, college or place of training fee-paying? If so, give details.

Part IV -- Childcare details

(a) Which parent looks after the children from day to day? If responsibility is shared, please give details.
(b) Give details of work commitments of both parents.
(c) Does someone look after the children when the parent is not there? If yes, give details.
(d) Who looks after the children during school holidays?
(e) Will there be any change in these arrangements? If yes, give details.

Part V -- Maintenance

(a) Does Plaintiff/Defendant pay towards the upkeep of the children? If yes, give details. Please specify any other source of maintenance.
(b) Is the maintenance referred to (a) above paid under court order? If yes, give details.
(c) Has maintenance for the children been agreed? If yes, give details.
(d) If not, will you be applying for a maintenance order from the court?

Part VI -- Details of contact with children

(a) Do the children see the Plaintiff/Defendant? Please give details.
(b) Do the children stay overnight and/or have holiday visits with the Plaintiff/Defendant. Please give details.
(c) Will there be any change to these arrangements?

Part VII -- Details of Health

(a) Are the children generally in good health? Please give details of any serious disability or chronic illness suffered by any of the children.
(b) Do the children or any of them have any special health needs? Please give details of the care needed and how it is to be provided.
(c) Are the Plaintiff and the Defendant generally in good health? In not, please give details.

Part VIII -- Details of care and other Court Proceedings

(a) Are the children or any of them in the care of a Health Board or under the supervision of a Social Worker or Probation Officer? If so, please specify.
(b) Are there or have there been any proceedings in any Court involving the children or any of them? If so, please specify. All relevant Court Orders relating to the children or any of them should be annexed hereto.

SWORN etc..