Circuit Court Forms

FORM 51B

 

AN CHÚIRT CHUARDA

THE CIRCUIT COURT

CIRCUIT                                                                                            COUNTY OF    

IN THE MATTER OF CIVIL PARTNERSHIP AND CERTAIN RIGHTS AND OBLIGATIONS OF COHABITANTS ACT 2010

BETWEEN

…………………………………………………….................... Applicant /Maintenance Creditor

AND

………………………………………………….......................... Respondent /Maintenance Debtor

IN THE MATTER OF SECTION *56(1) **179(1) OF THE CIVIL PARTNERSHIP AND CERTAIN RIGHTS AND OBLIGATIONS OF COHABITANTS ACT 2010

 

STATEMENT AS TO EARNINGS

 

I, ............., .......... [insert occupation], of ............., aged 18 years and upwards say as follows:—

 

1. I am the respondent/maintenance debtor [delete as appropriate] in the above entitled proceedings.

 

2. I have set out in the First Schedule the name and address of every employer by whom I am employed, together with particulars enabling each such employer to identify me, and particulars of my earnings and expected earnings from each such employment and other sources, my resources and needs.

 

FIRST SCHEDULE

 

†Name and address of Employer(s) .................

(or trustee of a pension scheme under which the maintenance debtor is receiving periodical pension benefits) ...............

Commencement date ................

Nature of work ...............

Place of Work .............

Weekly earnings ..............

Expected changes to weekly earnings ...........

Employee/contractor identification

number/code (if any) ................

P.P.S. number .................

‡Income from any other sources

Nature of income .............

Source ..................

Identification/account number/code (if any) ...............

Weekly income .............

‡Financial resources

Nature of resource ...............

Location (e.g. bank account) ................

Gross value .................

 

Needs

[Here set out full details of regular personal outings].

 

Dated: ................ 20

Signed ................... 

 

*For civil partnership proceedings

**For cohabitation proceedings

†Repeat for each separate employer, pension provider, or for income as self-employed

‡Repeat for each separate income source or, as the case may be, resource

OR

I, ............., ......... [insert occupation], of .........., aged 18 years and upwards say as follows:—

 

1. I am the employer of the maintenance debtor in the above entitled proceedings (or a trustee of a pension scheme under which the maintenance debtor is receiving periodical pension benefits).

 

2. I certify the following particulars of the maintenance debtor:

 

FIRST SCHEDULE

 

Name and address of Employer(s) .................

(or trustees) .................

Commencement date ...............

Nature of work ....................

Place of Work ................

Weekly earnings ...............

Expected changes to weekly earnings ...............

Employee/contractor identification number/code (if any)

of the maintenance debtor ....................

P.P.S. number of the maintenance debtor .................

 

Dated: ................ 20

Signed ..................... 

 

*For civil partnership proceedings

**For cohabitation proceedings