Document ID: chunk:federal_register_of_legislation:F2021C01008:schedule:3:p1
Version: federal_register_of_legislation:F2021C01008
Segment Type: schedule
Provision Reference: sch 3 (pt 1/7)
Character Range: 76573–80355

Schedule 3—Forms
(subregulation 3(2))

Form 1—Heading of documents for use in court proceedings
          (regulation 3A)

Family Law (Hague Convention on Intercountry Adoption) Regulations 1998

IN THE (insert name of court exercising jurisdiction)

                           NO.  (insert number of proceedings) of (insert year in which document is filed or issued)

DATE OF FILING:*/ISSUE:*  (insert date of filing or issue)

IN RELATION TO THE ADOPTION OF (insert forename(s) and surname(s) of child who is the subject of the proceedings) OR (otherwise identify the proceedings in accordance with the rules of the court)

___________________________________________________________

* omit if inapplicable

Form 2—Affidavit
          (paragraphs 14(2A)(b), 14(2D)(b), 14(2E)(b), 15(2A)(b), 15(2C)(b), 15(2D)(b), 20(2A)(b), 20(2D)(b), 20(2E)(b), 22(2A)(b), 22(2C)(b) and 22(2D)(b))

I*/WE*, (insert forename(s) and surname(s) of deponent(s)), (insert occupation(s) of deponent(s)), of (insert address of deponent(s)), declare the following under oath:
 (a) I*/We* am*/are* the deponent(s) for this document and have read the document and any attachment to the document; and
 (b) the facts stated in the document, and any attachment to the document, that are within my*/our* knowledge are correct; and
 (c) all other facts stated in the document, and in any attachment to the document, are correct to the best of my*/our* knowledge or belief.

SWORN by the deponent(s)
at (insert place where declaration made)
on (insert date of declaration)
     ...........................................................
     (signature(s) of deponent(s))

     ...................................................................................
     (name of deponent(s))

     ...................................................................................
     (title or position of deponent(s))

BEFORE ME:

     ...................................................................................
     (signature of person before whom affidavit is sworn)

     ...................................................................................
     (name of signatory)

     ...................................................................................
     (title or position of signatory)
___________________________________________________________
* omit if inapplicable

Form 3—Application for order
          (paragraphs 14(2A)(a), 15(2A)(a), 20(2A)(a) and 22(2A)(a))

(insert heading for document in accordance with Form 1)

Application for order under regulation 14*/15*/20*/22*

1 Identity of the child and his or her parents

1.1 Child
Surname:
Forenames:
Sex:
Age:
Date and place of birth:
Father's surname:
Other names:
Mother's maiden surname:
Other names:

1.2 Applicant(s)
    2.1 Mother:
Surname:
Other names:
Occupation:
Address:
    2.2 Father:
Surname:
Other names:
Occupation:
Address:

2 Order sought
Under regulation 14 of the Family Law (Hague Convention on Intercountry Adoption) Regulations 1998, application is made for an order for the adoption of (insert forename(s) and surname(s) of child), an Australian child, into (insert name of Convention country), a Convention country.

OR

Under regulation 15 of the Family Law (Hague Convention on Intercountry Adoption) Regulations 1998, application is made for an order for the adoption in Australia of (insert forename(s) and surname(s) of child) from (insert name of Convention country), a Convention country.

OR

Under regulation 20 of the Family Law (Hague Convention on Intercountry Adoption) Regulations 1998, application is made for an order terminating the legal relationship between (insert forename(s) and surname(s) of child) and his*/her* pre‑adoption parents.

OR
Under regulation 22 of