AN CHUIRT TEAGHLAIGH CHUARDA
(THE CIRCUIT FAMILY COURT)

LOCAL CIRCUIT YOUR COUNTY

IN THE MATTER OF THE FAMILY LAW (DIVORCE) ACT 1996
Between/

XXXXX
Applicant

-and-

YYYYY
Respondent

AFFIDAVIT OF WELFARE
I, (name) of (address), (occupation), aged 18 years and upwards, MAKE OATH and say as follows:

1. I say that I am the Applicant in the above proceedings and I make this Affidavit of Welfare from facts within my own knowledge, save where otherwise appears, and whereso appearing, I believe the same to be true.
2. I say and believe that the facts set out in the Schedule hereto are true.

SCHEDULE

Part I - Details of children

1. Details of the children born to (or adopted by) the Respondent and Applicant, with forenames, surnames and dates of birth.
2. Details of other children of the family, or children to whom either of the parties is in loco parentis.

Part II - Arrangements for children of the family
3. Home Details

(a) The address at which the children now live.
(b) Details of the number of living rooms, bedrooms at the above address(es).
(c) Is the house rented or owned? Name the tenant(s) or owner(s).
(d) Is the rent or mortgage being paid regularly and by whom?
(e) Give the names of all other person living with the children, full-time or part-time, and state their relationship to the children.
(f) Will there be any changes to these arrangements? If so, give details.

Part III - Education and training

(a) Give details of the school, college or place of training attended by each child.
(b) Do the children have special educational needs? Is so, please specify.
(c) Is the school, college or place of training fee-paying? If so, how much are the fees per term/year? Are fees being paid regularly and, if so, by whom?
(d) Will there be any changes in these circumstances? If so, give details.

Part IV - Childcare

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

Part V - Maintenance

(a) Does the Respondent pay towards the upkeep of the children? If so, give details. Specify any other sources of maintenance.
(b) Is the maintenance referred to above paid under Court order? If so, give details.
(c) Has maintenance been agreed for the children? If so, give details.
(d) If not, will you be applying for a maintenance order from the Court?

Part VI - Contact with the children

(a) Do the children see the Respondent? Give details.
(b) Do the children stay overnight and/or have holiday visits with the Respondent? Give details.
(c) Will there be any changes to these arrangements? If so, give details.

Part VII - Health

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

Part VIII - Care and other Court proceedings

(a) Are any of the children in the care of a health board or under the supervision of a social worker or probation officer? If so, give details.
(b) Have there been any Court proceedings involving any of the children? If so, give details. (All relevant Court orders should be annexed.)

Sworn by the said (name) before me,
a practising solicitor/Commissioner for Oaths, on (date),
at___________________and I know the deponent.
Signed: (name)_______________________________

Filed this__________day of_____________200_ by (name and address) solicitors for the Applicant.

To:

The Registrar,
Circuit Family Court

And/

Solicitor for the Respondent