Statement in support of
divorce / dissolution /
(judicial) separation
5 years’ separation
Section 1(2)(e) Matrimonial Causes Act 1973
Section 44(5)(c) Civil Partnership Act 2004
To be completed by the Petitioner
Name of court Case No.
Name of Petitioner
Name of Respondent
If completing this form by hand, please use black ink and BLOCK CAPITAL LETTERS and tick the boxes that apply.
About the petition
1. Have you read the petition for divorce dissolution (judicial) separation in this case?
Yes No
2. Do you wish to alter or add to any statement in the divorce / dissolution / (judicial) separation petition?
If Yes, please state the alterations or additions to be made.
Yes No
3. Subject to these alterations or additions (if any) is everything stated in your divorce / dissolution /
(judicial) separation petition true?
If any statement is not within your own knowledge, please indicate this and state whether it is true to the
best of your information and belief.
Yes No
4. State the date on which you and the Respondent separated.
D D
/
M M
/
Y Y Y Y
5. State the date on which you came to the decision that the marriage/civil partnership was at an end.
D D
/
M M
/
Y Y Y Y
D80E Statement in support - 5 years’ separation (04.14) © Crown Copyright 2014
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6. State, as far as you know, the various addresses at which you and the Respondent have respectively lived
since the date that you separated, and the periods of residence at each address.
From/to
(dd/mm/yy)
Petitioner’s address From/to
(dd/mm/yy)
Respondent’s address
7. Since the date that you separated, have you ever lived with the Respondent in the same household?
Yes No
If Yes, state the address and the period giving dates to the best of your knowledge or belief. Please also
explain the domestic circumstances when you separated.
Address(es) Dates
From To
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
D D
/
M M
/
Y Y Y Y D D
/
M M
/
Y Y Y Y
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If the Respondent has
personally signed the
acknowledgement of
service, you must attach
a copy to this statement
and tick the relevant
box(es), except that if
the acknowledgement of
service has been signed by
a solicitor acting on behalf
of the Respondent you do
not need to refer to it or
attach to this statement.
I identify the signature appearing in paragraph 10(a) of the acknowledgement of
service, a copy of which I have attached to this statement and marked ‘A, as the
signature of my spouse civil partner, who is the Respondent in
these proceedings.
I identify the signature appearing in the attached statement
dated
D D
/
M M
/
Y Y Y Y
, and marked ‘B’ as the signature of the Respondent.
I ask the court to grant a decree / an order dissolving my marriage civil partnership, or for (judicial)
separation from the Respondent on the fact(s) stated in my petition
and (provided you have applied for costs in your petition for divorce / dissolution / (judicial) separation) to order the
Respondent to pay the costs of this application.
Statement of Truth – the Petitioner must complete and sign this section
I believe that the facts stated in this statement in support of the petition for divorce/dissolution/(judicial)
separation are true
Print full name
Signed
Dated
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.
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