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C100 Application under the Children Act 1989 or a residence, contact, prohibited steps, specifc issue section 8 order or to vary or discharge a section 8 order (04.11)

Crown copyright 2011

C100

Have you applied to the court or

permission to make this application?

Your name (the applicant(s))

The respondents name(s)See Sections G and H o the booklet CB1.

Yes Permission not required

1. Summary o application

Some people need permission to apply - See Section C o the leaet CB1 or details on who needs permission and

how to get permission

To be completed by the court

Name o court

Date issued

Case number

Please list the name(s) o the child(ren) and the type(s) o order you are applying or, starting with the oldest. To

understand which order to apply or read the booklet CB1 Section D.

Child 1 - Full name o child Date o birth Gender Order(s) applied or

D D / M M / Y Y Y YMale

Female

Relationship to applicant(s) Relationship to respondent(s)

Application under the ChildrenAct 1989 or a residence, contact,prohibited steps, specic issuesection 8 order or to vary or

discharge a section 8 order

Beore completing this orm please read the leaet CB1 Making an application Children and the Family

Courts. You can get a copy o rom your local court or at www.justice.gov.uk.

Failuretocompleteeveryquestionorstateifitdoesnotapply,coulddelaythecase,asthecourtwillhavetoask

you to provide the additional inormation required.

Ifthereisnotenoughspacepleaseattachseparatesheets,clearlyshowingthedetailsofthechildren,parties,

question and page number they reer to.

Cafcass/CAFCASSCYMRUwillcarryoutchecksasitconsidersnecessary.SeeSectionJofleaetCB1formore

informationaboutCafcassandCAFCASSCYMRU.



Female




Female


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2.Aboutyou(theapplicant(s)))

Applicant 1 (You) Applicant 2 (i applicable)

Full names

Previous names (i any)

Gender Male Female Male Female

Dateofbirth(Ifunder18read

section R o leaet CB1)D D / M M / Y Y Y Y D D / M M / Y Y Y Y

Place o birth

(town/county/country)

I you do not wish your address to be made known to the respondent, leave

thedetailsbelowblankandcompleteCondentialcontactdetailsFormC8.

Address

Home telephone number

Mobile telephone number

Email address

Have you lived at this address or

more than 5 years?

Yes No Yes No

IfNo,pleaseprovidedetailsofallpreviousaddressesyouhavelivedatforthelast 5 years.

Ifyoudonotwishyourcontact

details to be made known to the

Respondent, leave the details

blank and complete Condential

contactdetailsFormC8

Postcode Postcode

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3. The respondents

Sections G and H o the the booklet CB1 - Making an application - Children and the Family Courts explain who a

respondent is.

Iftherearemorethan2respondentspleasecontinueonaseparatesheet.

Respondent 1 Respondent 2

Full names

Previous names (i known)


Dateofbirth(Ifpartyunder18

read section R o leaet CB1) D D / M M / Y Y Y Y D D / M M / Y Y Y Y

Place o birth

(town/county/country)

Address(towhichdocuments

relating to this application

should be sent)

Home telephone number

Mobile telephone number

Email address

Have they lived at this addressor more than 5 years? Yes No Dont know Yes No Dont know

IfNo,pleaseprovidedetailsofallpreviousaddressesforthelast5yearsbelow

(i known, including the dates and starting with the most recent)

Postcode Postcode

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4. Others who should be given notice

There may be other people who should be notied o your application, or example, someone who cares or the

childbutisnotaparent.SectionsGandIofthethebookletCB1 - Making an application - Children and the

Family Courts explain who others are.

Person1 Person 2

Full names

Previous names (i known)


Date o birth D D / M M / Y Y Y Y D D / M M / Y Y Y Y

Address

Please state their relationship to

thechildrenlistedonpage1.If

their relationship is not the same

to each child please state their

relationship to each child.

Postcode Postcode

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5. Solicitors details

Do you have a solicitor acting

or you?Yes No IfNo,seesectionRofleaetCB1formoreinformation

IfYes,pleasegivethefollowingdetails

Your solicitors name

Name o rm

Address

Telephone number

Fax number

DX number

Solicitors Reerence

Email address

Postcode

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6. The child(ren)

Areanyofthechildrenknown

to the local authority childrens

services?

Yes No Dont know

IfYespleasestatewhichchild

and the name o the Local

AuthorityandSocialworker

(i known)

Areanyofthechildrenthe

subject o a child protection planYes No Dont know

Do all the children share the

same parents?Yes No

IfYes,whatarethenameofthe

parents?

IfNo,pleasegivedetailsof

each parent and their children

involved in this application

Please state everyone who has

parental responsibility or eachchild and how they have parental

responsibility (e.g. childs mother,

childs ather and was married to

the mother when the child was

born etc.)

(See Section E o leaet CB1 or

more inormation)

Who do the children currently

live with?Applicant(s) Respondent(s) Other

Ifother,pleasegivethefulladdress o the child, the names

o any adults living with the

children and their relationship to

or involvement with the child.

Ifyoudonotwishthis

inormation to be made known to

the Respondent, leave the details

blank and complete Condential

contactdetailsFormC8

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7. Why are you making this application?

Please give brie details:

anypreviousagreements(formal

or inormal), and how they have

broken down

yourreasonsforbringingthis

application to the court

whatyouwantthecourttodo

reasonsgivenbythe

respondent(s) or their actions in

relation to this application.

Do not give a ull statement, please provide a summary o any relevant grounds

and reasons. You may be asked to provide a ull statement later.

8.Agreementsaboutresidenceand/orcontact

Please give brie details about:

Ifyouattendedamediation

inormation/assessment meeting

what was the outcome?

Ifyouattendedfullmediation

sessions what was the outcome?

Ifyoudidnotusemediation

please explain why

Have you received a copy o the

Parenting Plan: Putting your children

rst:Aguideforseparating parents, booklet?

Yes No IfNo,youcangetacopyfreeofchargefromyour

local court or you can download a copy rom the

website www.tso.co.uk

Have you attended a mediation

inormation/assessment meeting as

suggested in the pre-action protocol

and/or attached orm FM1?

Yes NoYou can nd your nearest amily mediation service

by visiting the governments website DirectGov(www.direct.gov.uk) and search using the words

amily mediation. You will nd a database o

accredited amily mediation services on the website.

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10. Other court cases which concern the child(ren) listed on page 1

Areyouawareofanyothercourt

cases now, or at any time in the past,

which concern any o the child(ren)

at Section 1?

Yes IfYes,pleaseattachacopyofanyrelevantorder,andcompletedthe

detailsoftheCafcass/CAFCASSCYMRUocerandchildssolicitor

below.Ifyoudonothaveacopyoftheorderpleasecompleteallthe additional details below.

No IfNo,pleasego to Section 11

Additional details

Name o the court where

proceedings heardCase no.

Date/year (i known)

Nameandoce(ifknown)of

Cafcass/CAFCASSCYMRUocer

Name and address o childs

solicitor, i known

I the above details are diferent or each child please provide

details on additional sheets.

Please tick i additional

sheets are attached.

Name o child(ren)

9. Risk

Do you believe that the child(ren)

named at Section 1 have

experienced or are at risk o

experiencing harm rom any o the

ollowing by any person who has

had contact with the child?

any orm o domestic abuse/violence Yes No

child abduction Yes No

child abuse Yes No

drugs, alcohol or substance abuse Yes No

other saety or welare concerns Yes No

IfyouansweredYestoanyoftheabove,pleasecompleteformC1A

(Supplemental inormation orm).

Postcode

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12. Statement o truth

11.Attendingthecourt

Section N o the the booklet CB1 - Making an application - Children and the Family Courts provides inormation

about attending court.

I you require an interpreter, you must tell the court now so that one can be arranged.

IfYes,pleasespecifythelanguageanddialect:

Do you or any o the parties need

an interpreter at court?Yes No

Ifattendingthecourt,doyouor

any o the parties involved have

a disability or which you require

special assistance or special acilities?

Yes No

IfYes,pleasesaywhattheneedsare

Please say whether the court needs

to make any special arrangements

or you to attend court (e.g.

providing you with a separate

waiting room rom the respondent

or other security provisions).

Court staf may get in touch with you about the requirements

continued over the page

*[Ibelieve][Theapplicant/respondent]thatthefactsstatedinthisapplication

are true.

*Iamdulyauthorisedbytheapplicant/respondenttosignthisstatement.

Print ull name

Name o applicant solicitors rm

Signed Dated D D / M M / Y Y Y Y

(Applicant)(Applicantssolicitor)

Positionoroceheld

(Ifsigningonbehalfofrmor

company)

Proceedings or contempt o court may be brought against a person who

makes or causes to be made, a alse statement in a document veried bya statement o truth.

*delete asappropriate

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What to do now

Check you have attached copies o any

relevant orders (as per Section 10).

Check you have completed and signed Section 12.

You must provide a copy o the application and

attached documents or each o the respondents and

onefortheChildrenandFamilyCourtAdvisoryand

SupportService(CafcassorCAFCASSCYMRU).

Check you have included dates o birth or all parties

and children

IsFormC1Aattached(ifapplicable)?

Areanyadditionalsheetsattached?

Ifyouhaveincludedadditionalsheetsyoumustadd

the names o the parties and children at the top o the

page and details o the questions and page number

the additional sheets relate to.

Check you have attached the correct ee. The leaet

EX50 County court ees provides inormation about

court ees you will have to pay.

Now take or send your application with the correct ee

and correct number o copies to the court.

Court ees

You may be exempt rom paying all or part o the ee.

The combined booklet and application orm

EX160ACourtFees-Doyouhavetopaythemgives

more inormation. You can get a copy rom the court or

download a copy rom our website at

www.justice.gov.uk

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