Fill - Free fillable Application for inherent jurisdiction order in relation to (Cabinet Office) PDF form

C66

Your name (the applicant(s))

The respondent’s name(s)

Summary of application

To be completed by the court

Name of court

Date issued

Case number

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

Name of child(ren) Gender Date of birth Order(s) applied for.

D D

M M

Y Y Y Y

D D

M M

Y Y Y Y

D D

M M

Y Y Y Y

D D

M M

Y Y Y Y

Application for inherent

jurisdiction order in

relation to children

In the High Court of Justice Family Division

Principal Registry/District Registry.

Before completing this application please read the booklet ‘CB1 – Making an application – Children and the

Family Courts’. You can get a copy of all the forms and leaets from your local court or they can be found at

hmctsformnder.justice.gov.uk

Cafcass/CAFCASS CYMRU will carry out checks as it considers necessary.

Cafcass - Children and Family Court Advisory and Support Service (in England); CAFCASS CYMRU -

Children and Family Court Advisory and Support Service Wales.

Give details of any xed

hearing date or period?

Help with Fees – Ref no.

(if applicable)

H W F

– –

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1. About you (the applicant)

Your rst name

Middle name(s)

Surname

Previous surnames (if any)

Date of birth

D D

M M

Y Y Y Y

Gender Male Female

Place of birth

(town/county/country)

If you do not wish your address to be made known to the

respondent, leave the address details blank and complete

Condential Address Form C8. You can get a copy of this form from any

family court ofce or from our website at hmctsformnder.justice.gov.uk

Address

Home telephone number

Mobile telephone number

Have you lived at this address

for more than 5 years?

Yes No

If No, please provide details of all previous addresses you have lived at

for the last 5 years.

Postcode

Do you have a solicitor acting

for you?

Yes No

If Yes, please give the following details

Your solicitor’s name

Name of rm

Address

Telephone number

Fax number

DX number

Solicitor’s Reference

Fee account no.

Your solicitor’s details

Postcode

2. The child(ren)

Please give details of the child(ren) and the order(s) you are applying for.

If there are more than 4 children please continue on a separate sheet.

Child 1

Child’s rst name

Middle name(s)

Surname

Gender

Male Female

Child 2

Child’s rst name

Middle name(s)

Surname

Gender

Male Female

Child 3

Child’s rst name

Middle name(s)

Surname

Gender

Male Female

Child 4

Child’s rst name

Middle name(s)

Surname

Gender

Male Female

Relationship to the child(ren)

Name of child Relationship

If you do not wish the child’s address to be made known to the

respondent, leave the address details blank and complete Condential

contact details form C8. You can get a copy of this form from any family

court ofce or from our website at hmctsformnder.justice.gov.uk

Child(ren)’s address

(If known)

Any other information about the

child’s whereabouts. If you do

not know where the child is you

must state this.

Do you have any reason to

believe that any child, parent

or potentially signicant adult in

the child’s life may be habitually

resident in another state?

Yes No

If Yes, please give details

Please give brief details

about why you are making

this application including any

facts you are relying on.

Does your application include

any issues under the Human

Rights Act 1998?

Yes No Don’t know

4. Why are you making this application?

3. About your application

What do you want the

court to do?

Do not give a full statement, please provide a summary. You may be

asked to provide a full statement later.

5. Family mediation

If you did not use mediation

please explain why.

Have you used family mediation

to attempt to agree arrangements

for your children?

Yes No

You can nd your nearest family mediation

service by visiting the government’s website

DirectGov (www.direct.gov.uk) and search

using the words ‘family mediation’. You will

nd a database of accredited family mediation

services on the website

6. Risk

Do you believe that the child(ren)

named at Section 2 have suffered

or are at risk of suffering any harm

from any of the following:

• any form of domestic abuse

• violence within the household

• child abduction

• other conduct or behaviour

by any person who has had

contact with the child?

Yes No

If Yes, please complete form C1A (Supplemental information form).

If Other, please give details

7. Other court cases which concern the child(ren) listed at Section 2

Are you aware of any other court

cases now, or at any time in the

past, which concern any of the

child(ren) at Section 2?

Yes If Yes, please attach a copy of any relevant order and

give additional details below

No If No, please go to Section 8

Additional details

Name of the court where

proceedings heard

Case no.

Date/year (if known)

Name of Cafcass/CAFCASS

CYMRU ofcer

If the above details are different for each child please provide

details on additional sheets.

Name of child(ren)

Type of proceedings if known -

please tick all that apply

Emergency Protection Order

Yes No

Supervision Order

Yes No

Care Order

Yes No

Child abduction

Yes No

Family Law Act 1996 Part 4 (proceedings for

non-molestation order or occupation order)

Yes No

A contact or residence order (Section 8 Children

Act 1989) made within proceedings for a divorce

or dissolution of a civil partnership

Yes No

A contact or residence order (Section 8 Children

Act 1989) made in connection with an Adoption

Order

Yes No

An order relating to child maintenance

(Schedule 1 Children Act 1989)

Yes No

A child arrangements order

(Section 8 Children Act 1989)

Yes No

Please tick if additional

sheets are attached.

8. The respondents

If there are more than 2 respondents please continue on a separate sheet.

Respondent’s rst name

Middle name(s)

Surname

Previous surnames (if known)

Date of birth

D D

M M

Y Y Y Y

Gender Male Female

Place of birth

(town/county/country, if known)

Address

Have they lived at this address

for more than 5 years?

Yes No Don’t know

If No, please provide all previous addresses for the

last 5 years below, if known.

Relationship to the child(ren)

Name of child Relationship

Respondent 1

Postcode

Respondent’s rst name

Middle name(s)

Surname

Previous surnames (if known)

Date of birth

D D

M M

Y Y Y Y

Gender Male Female

Place of birth

(town/county/country, if known)

Address

Have they lived at this address

for more than 5 years?

Yes No Don’t know

If No, please provide all previous addresses for the

last 5 years below, if known.

Relationship to the child(ren)

Name of child Relationship

Respondent 2

Postcode

9. Statement of truth

(*Delete as appropriate)

*(I believe)(The applicant believes) that the facts stated in this

application are true.

*I am duly authorised by the applicant to sign this statement.

Print full name

Signed

*(Applicant)(Legal Representative)(Applicant’s solicitor)

Date

D D

M M

Y Y Y Y

Proceedings for contempt of court may be brought against a person who

makes or causes to be made a false statement in a document veried by

a statement of truth.

continued over the page

10. Attending the court

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

If Yes, please specify the language and dialect:

Do you or any of the parties

need an interpreter at court?

Yes No

If attending the court, do you or

any of the parties involved have

a disability for which you require

special assistance or special

facilities?

Yes No

If Yes, please say what the needs are

Please say whether the court

needs to make any special

arrangements for you to attend

court (e.g. providing you with a

separate waiting room from the

respondent or other security

provisions).

Court staff may get in touch with you about the requirements

You must attach one of the following documents to this application for

each child.

a certied copy of a full birth certicate that gives details of the

child’s mother and father

a certied copy of the entry in the Adopted Children’s Register

if neither is available, I request to the court to give directions at the

rst hearing as to proof of the child’s birth

A full birth certicate shows

surname, forenames, date of birth,

sex, place of birth (where known),

parent(s) name(s), their address and

occupation at time of registration.

11. Documents to be attached

In urgent cases, the court may allow the application to be issued

without the Birth Certicate, Certied entry in the Adopted Children’s

Please conrm when copies of the Certicate/entry to Adopted

Children’s Register/directions as to proof of the child’s birth will

be made available to the court

D D

M M

Y Y Y Y

TAKE NOTICE that-

(1) You must within 14 days of service of this application le in the court mentioned on the C6 Notice of

proceedings a notice stating your address and the whereabouts of the child (or that you are unaware of

the child’s whereabouts if that is the case).

(2) Unless the court directs otherwise you must serve a copy of that notice on the applicant.

(3) If you subsequently change your address or become aware of any change in the child’s whereabouts,

you must, unless the court directs otherwise, le in the above-mentioned court notice of your new

address or of the new whereabouts of the child, as the case may be, and serve a copy of that notice on

the applicant.

Any notice required to be lodged in the above-mentioned court shall be sent to the court address or delivered

to Family Division of the High Court, 1

Mezzanine, Queens Building, Royal Courts of Justice, Strand, London

WC2A 2LL.

To the respondent(s) (other than the child)

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