This is a mandatory form*.

This form is to be used:

(a) when allegations of child abuse or risk of child abuse are made and a prescribed child welfare authority must be notified of the allegations (Section 67Z of the Family Law Act 1975), or

(b) if, in a case where an application is made to the court for a Part VII order in relation to a child, a person alleges that there has been abuse of a child or family violence or there is a risk of abuse of a child or family violence and the allegation of abuse, family violence or risk of abuse or family violence is relevant to whether the court should grant or refuse the application (Section 67ZBA of the Family Law Act 1975, and Rule 2.04E of the Family Law Rules 2004).

For proceedings commenced before 7 June 2012.

Section 4(1) of the Family Law Act states as follows:

Abuse, in relation to a child, means:

(a) an assault, including a sexual assault, of the child which is an offence under a law, written or unwritten, in force in the State or Territory in which the act constituting the assault occurs; or

(b) a person involving the child in a sexual activity with that person or another person in which the child is used, directly or indirectly, as a sexual object by the first-mentioned person or the other person, and where there is unequal power in the relationship between the child and the first mentioned person.

Family violence means conduct, whether actual or threatened, by a person towards, or towards the property of, a member of the person's family that causes that or any other member of the person's family reasonably to fear for, or reasonably to be apprehensive about, his or her personal wellbeing or safety.

For proceedings commenced on or after 7 June 2012.

Section 4(1) of the Family Law Act states as follows:

Abuse, in relation to a child, means:

(a) an assault, including a sexual assault, of the child; or

(b) a person (the first person) involving the child in a sexual activity with the first person or another person in which the child is used, directly or indirectly, as a sexual object by the first person or the other person, and where there is an unequal power in the relationship between the child and the first person; or

(c) causing the child to suffer serious psychological harm, including (but not limited to) when that harm is caused by the child being subjected to, or exposed to, family violence; or

(d) serious neglect of the child.

A family violence order is an order (including an interim order) made under a prescribed law of a state or territory to protect a person from family violence.

Family violence means:

  • violent, threatening or other behaviour by a person that coerces or controls a member of the person's family (the family member), or causes the family member to be fearful; and
  • a child is exposed to family violence if the child sees or hears family violence or otherwise experiences the effects of family violence (Section 4AB).

Note: The forms for use in the Federal Circuit Court and Family Court of Western Australia and information about procedures in these courts is available on the Federal Circuit Court and Family Court of Western Australia websites www.federalcircuitcourt.gov.au and www.familycourt.wa.gov.au.

Making copies of the form for filing, service and yourself

The completed and signed original of the form is filed at the Court. Before you file it you must also make sufficient copies to have one for each person to be served and a copy for your own records.

Filing fee

Nil

What you file with this form

An affidavit or affidavits setting out the evidence on which the allegations in the Notice of Child Abuse, Family Violence or Risk of Family Violence are based (Rule 2.04D).

How to complete Parts E, F, G and H

The answers to questions 10, 11, 12, 14, 15, 16, and 18, 19, and 20 are to be a concise summary of the precise allegations and details of each of them including dates they occurred, and any other particulars which reflect the contents of the affidavit evidence.

Who you serve

  • Each party to the case
  • The person who is alleged to have abused the child, or exposed the child to family violence
  • The person from whom the child is alleged to be at risk of abuse or family violence
  • Any independent children's lawyer who represents the interests of the child.

NOTE: The Registry Manager must provide a copy of the Notice of Child Abuse, Family Violence or Risk of Family Violence to the prescribed child welfare authority and may provide such other court documents and information as is required to enable investigation of the contents of the Notice.

How you serve this form

By ordinary service. The Service Kit provides instructions on how to do this.

What is filed in response

Nothing

In completing a court form, you must

  • Use the Court's prescribed form (available on this page)
  • Complete the form by typing (e.g. on a computer or typewriter) or hand printed in ink.

* For further information or to get paper copies of this document sent to you, call 1300 352 000, or visit a family law registry near you.

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Are you having trouble understanding legal words used in these forms?

NOTE: LawTermFinder allows searches in the following languages: العربية | Arabic, 简体中文 | Simplified Chinese, 繁體中文 | Traditional Chinese,
한국어 | Korean, Español | Spanish, Tiếng Việt | Vietnamese.