FLR-15A-E (2008/04)
Page 1 of 9
ONTARIO
(Name of Court)
at
Court office address
Court file number
Form 15A: Change
Information Form
Applicant(s)
Full legal name & address for service — street & number, municipality,
postal code, telephone & fax numbers and e-mail address (if any).
Lawyer’s name & address — street & number, municipality, postal code,
telephone & fax numbers and e-mail address (if any).
Respondent(s)
Full legal name & address for service — street & number, municipality,
postal code, telephone & fax numbers and e-mail address (if any).
Lawyer’s name & address — street & number, municipality, postal code,
telephone & fax numbers and e-mail address (if any).
Assignee (if applicable)
Full legal name & address for service — street & number, municipality,
postal code, telephone & fax numbers and e-mail address (if any).
Lawyer’s name & address — street & number, municipality, postal code,
telephone & fax numbers and e-mail address (if any).
PART 1 – GENERAL INFORMATION
(This part should be filled out to the best ability of the party asking for a change in an order or support agreement.)
My name is (full legal name)
I live in (municipality & province)
and I that the following is true:
1. I am the
applicant respondent
2. The applicant, (applicant’s full legal name)
was born on (date of birth)
lives in (municipality & province)
and, at the present time, is
married living in a spousal relationship
separated other (specify)
The applicant is the
support recipient support payor
3. The respondent, (respondent’s full legal name)
was born on (date of birth)
lives in (municipality & province)
and, at the present time, is
married living in a spousal relationship
separated other (specify)
The respondent is the
support recipient support payor
Sworn/Affirmed
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 2)
Court file number
4. This order/agreement has never been assigned
has been assigned to
the Ontario Ministry of Community and Social Services
Ontario Works in
(name of location)
the municipality of
(name)
other
(specify)
The details of the assignment are: (Give date of assignment, indicate whether it is still in effect, add any other relevant
information known to you and attach a copy of the Confirmation of Assignment Form.)
5. The applicant and the respondent:
started living together on
(date)
were married on
(date)
never lived together
separated on
(date)
were divorced on
(date)
6. The following chart gives basic information about the child(ren) in this case:
(List all child(ren) involved in this case, even those for whom no support is being claimed.)
Child’s full
legal name
Age
Birthdate
(d, m, y)
Lives in
(municipality & province)
Now living with
(name of person and
relationship to child)
Support
claimed
for child?
(YES or NO)
7. I attach a copy of the existing
court order agreement
that contains the term(s) to be changed.
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 3)
Court file number
8. The existing custody and access arrangements for the child(ren) are as follows:
Child’s name Custody/Access Arrangement
9. The details of the existing order/agreement with respect to support are as follows:
Date of order or
agreement
Present child support
payment
$
per
Other terms of child support
Present support payment
(if any) for spouse
$
per
10. The payment status of the existing order/agreement as of today is as follows:
all payments have been made
arrears are owing as follows:
Child support owed to
recipient
$
Child support owed
to other(s)
(such as Ministry of Community
and Social Services)
$
Spousal support owed to
recipient
$
Spousal support owed
to other(s)
(such as Ministry of Community
and Social Services)
$
CUSTODY/ACCESS
(Complete only if you are asking for a change in an order for custody or access.)
11. I ask that
(name(s) of party(ies) and/or person(s))
have custody of the
following child(ren)
(name(s) and birthdate(s) of child(ren))
12. I ask that
(name of party)
have access to the following child(ren)
(name(s) and birthdate(s) of child(ren))
as follows:
(give details of access)
OR
13. I ask that
(name(s) of party(ies) and/or person(s))
and
have joint custody of the following child(ren)
(name(s) and birthdate(s) of child(ren))
14. I ask for the following residential/access arrangements for the child(ren):
(name(s) and birthdate(s) of child(ren))
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 4)
Court file number
15. The order I am asking the court to make is in the best interests of the child(ren) for the following reasons: (give details)
CHILD SUPPORT
(Complete this section only if you are asking for a change in child support.)
16. I am asking to change the child support in the order/agreement because:
The order/agreement was made before the applicable Child Support Guidelines came into effect.
The following change in circumstances has taken place: (Give details of change in circumstances.)
The parties agree to the termination of the support order/agreement, dated
,
for the following child(ren):
(name(s) and birthdate(s) of child(ren))
,
as of
(date)
.
Other:
(give details)
17. I ask that the child support be changed as follows:
The order/agreement for child support dated
be terminated for the following
child(ren):
(insert name(s) and birthdate(s) of child(ren))
effective
(date)
.
Based on the payor’s income of $
per year,
(name of party)
pay child support to
(name of party)
in the amount of $ per month for the following child(ren) (name(s) and birthdate(s) of child(ren))
with payments to start on
(date)
.
This amount is the table amount listed in the Child Support Guidelines.
This amount is more than the table amount listed in the Child Support Guidelines.
This amount is less than the table amount listed in the Child Support Guidelines. (If this box is checked, you
must complete paragraph 18.)
Starting on
(date)
,
(name of party)
pay to
(name of party)
$ for the following
special or extraordinary expenses:
Child’s Name Type of Expense
Total Amount
of Expense
Payor’s Share
Terms of Payment
(frequency of payment,
date due, etc.)
$ $
$ $
$ $
$ $
$ $
$ $
Other:
(give details)
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 5)
Court file number
18.
I am asking that child support be changed to an amount that is less than the table amount listed in the Child
Support Guidelines. The reason(s) for my request is/are that:
The parties agree to a different amount.
I have attached a separate sheet to this form that explains why this is an appropriate amount of child
support.
The recipient is getting social assistance payments from a public agency whose consent to this
arrangement is needed. I am attaching the agency’s consent to this form.
As can be seen from paragraphs 6 and 8 above, the parties have shared custody of the child(ren) (the payor
has a child at least 40% of the time).
I have attached a separate sheet to this form that compares the table amounts from the Child Support
Guidelines for each of the parties, shows the increased cost of the shared custody arrangement, the
financial circumstances of each party and of each child for whom support is claimed.
The parties are agreeing to this arrangement and I have attached a separate sheet to this form that
explains why this is an appropriate amount of child support.
As can be seen from paragraphs 6 and 8 above, custody of the children is split between the parties. I have
attached a separate sheet to this form that calculates the difference between the amount that each party
would otherwise pay to the other under the Child Support Guidelines.
A child is 18 or more years old and I attach to this form a separate sheet that calculates the amount of
support for this child.
A child contributes to his/her own support and I attach to this form a separate sheet showing the amount of
the child’s own income and/or assets.
The payor’s annual income is over $150,000 and I have attached to this form a separate sheet that calculates
the amount of support that I want to be put in an order.
Under the order/agreement,
(name(s) of child(ren))
is/are the subject of special provisions that I have detailed on a separate sheet that I have attached to this form.
The payor stands in the place of a parent to
(name(s) of child(ren))
and I attach to this form a separate sheet that gives the details of another parent’s duty to pay support for this/
these child(ren), as well as the details of the calculation of the amount of support requested.
The amount listed in the Child Support Guidelines would cause undue hardship to me or to the child(ren) for
whom support is claimed. I attach to this form a separate sheet that compares the standards of living of the
parties and calculates the amount of support that should be paid.
19. I ask that the outstanding child support owed be paid as follows:
The child support owed to
(name of recipient)
be fixed at $ as of
(date)
.
(Name of payor)
pay to (name of recipient)
$ per month, with payments to begin on (date)
until the full amount owing is paid.
The child support owed to
(name of agency or other person)
be fixed at $ as of
(date)
.
(Name of payor)
pay to (name of agency or other person)
$ per month, with payments to begin on (date)
until the full amount owing is paid.
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 6)
Court file number
SPOUSAL SUPPORT
(Complete only if you are asking for a change in spousal support.)
20. I am asking to change the spousal support in the order/agreement because:
The following change in circumstances has taken place:
(give details of change in circumstances.)
Spousal support should no longer be paid as of
(date)
for the following reasons:
(give details)
The parties consent to the termination of the spousal support order/agreement, dated ,
as of
(date)
.
Other
(give details):
21. I ask that the spousal support be changed as follows:
The order/agreement for spousal support, dated , be terminated
effective
(date)
.
(Name of party)
pay spousal support to
(name of party)
in the amount of $ per month,
effective on
(date)
.
Other
(give details of the order you want the court to make)
22. I ask that the outstanding spousal support owed be paid as follows:
The spousal support owed to
(name of recipient)
be fixed at $ as of
(date)
.
(Name of payor)
pay to (name of recipient)
$ per month, with payments
to begin on
(date)
until the full amount owing is paid.
The spousal support owed to
(name of agency or other person)
be fixed at $ as of
(date)
.
(Name of payor)
pay to (name of agency or other person)
$ per month, with payments
to begin on
(date)
until the full amount owing is paid.
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 7)
Court file number
OTHER
(Complete if applicable.)
23. I ask that the term(s) of the order of Justice
(name of judge)
,
dated , for
(give details)
be changed as follows:
(give details of the order you want the court to make)
24. I ask that the court make this order for the following reasons:
before me at
municipality
in
province, state or country
on
date
Commissioner for taking affidavits
(Type or print name below
if signature is illegible.)
Signature
(This form is to be signed in front of a
lawyer, justice of the peace, notary public or
commissioner for taking affidavits.)
Sworn/Affirmed
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 8)
Court file number
PART 2 – INFORMATION FROM SUPPORT PAYOR
DO NOT COMPLETE THIS PART IF THE PARTIES ARE ONLY CONSENTING TO TERMINATE A SUPPORT
OBLIGATION OR IF THE MOTION TO CHANGE DOES NOT INCLUDE A CLAIM TO CHANGE CHILD SUPPORT.
My name is
(full legal name)
I live in
(municipality & province)
and I that the following is true:
25. I am the support payor in this case.
26. I attach the following financial information about myself:
(a) a copy of every personal income tax return that I filed with Canada Revenue Agency for the 3 most recent
taxation years;
(b) a copy of every notice of assessment or re-assessment from Canada Revenue Agency of those returns; and
(c)
(applies only if you are an employee) proof of this year’s earnings from my employer as required by clause
21(1)(c) of the Child Support Guidelines.
(applies only if you are self-employed, or you are a partner in a partnership or you control a corporation or are a
beneficiary under a trust)
the documents listed in clauses 21(1)(d), (e), (f) or (g) of the Child Support
Guidelines.
27. My total income
will be $ for this year;
was $ for last year; and
was $ for the year before that.
28. On the basis of my annual income, the table amount from the Child Support Guidelines for (number of child(ren))
child(ren) is $ per month.
29. My financial statement is attached. is not attached.
before me at
municipality
in
province, state or country
on
date
Commissioner for taking affidavits
(Type or print name below
if signature is illegible.)
Signature
(This form is to be signed in front of a
lawyer, justice of the peace, notary public or
commissioner for taking affidavits.)
Swear/Affirm
Sworn/Affirmed
FLR-15A-E (2008/04)
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Form 15A: Change Information Form (page 9)
Court file number
PART 3 – INFORMATION FROM SUPPORT RECIPIENT
DO NOT COMPLETE THIS PART IF THE PARTIES ARE ONLY CONSENTING TO TERMINATE A SUPPORT
OBLIGATION OR IF THE MOTION TO CHANGE DOES NOT INCLUDE A CLAIM TO CHANGE CHILD SUPPORT.
My name is
(full legal name)
I live in
(municipality & province)
and I that the following is true:
30. I am the support recipient in this case.
Fill in paragraphs 31 and 32 only if:
. the change for which you are asking is for an amount that is different from the Child Support Guidelines;
. the change for which you are asking relates to a child
. over the age of 18 years,
. for whom the payor stands in the place of a parent, or
. with respect to whom the payor has access or physical custody not less than 40% of the time over the course of the year;
. each party has custody of one or more children;
. the payor’s annual income as determined under the guidelines is more than $150,000;
. either party claims that an order according to the guidelines would result in undue hardship; or
. there is a claim for special or extraordinary expenses.
31. I attach the following financial information about myself:
(a) a copy of every personal income tax return that I filed with Canada Revenue Agency for the 3 most recent
taxation years;
(b) a copy of every notice of assessment or re-assessment from Canada Revenue Agency of those returns; and
(c)
(applies only if you are an employee) proof of this year’s earnings from my employer as required by clause
21(1)(c) of the Child Support Guidelines.
(applies only if you are self-employed, or you are a partner in a partnership or you control a corporation or are a
beneficiary under a trust)
the documents listed in clauses 21(1)(d), (e), (f) or (g) of the Child Support
Guidelines.
32. My total income
will be $ for this year;
was $ for last year; and
was $ for the year before that.
33. My financial statement is attached. is not attached.
before me at
municipality
in
province, state or country
on
date
Commissioner for taking affidavits
(Type or print name below
if signature is illegible.)
Signature
(This form is to be signed in front of a
lawyer, justice of the peace, notary public or
commissioner for taking affidavits.)
Swear/Affirm
Sworn/Affirmed
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