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FM1
Application for collection of maintenance payments

You can tell CSA about the changes by phoning 131 272
CSA 1634–06.2005

This form can be submitted online.

Use this form if you have a court order or court registered agreement for payment of child or spouse maintenance and you want CSA to collect the payments for you.

About you

1. Your name
Title
Surname
Given name(s)

2. Your former name if you have changed your name
Surname
Given names

Which name would you like us to use in CSA letters to you and the payer?
   


3. Your postal address
 
State   Postcode  

4. Your home address
 
State   Postcode  

5. Date of birth
(dd/mm/yyyy)

6. Your phone numbers
Home Is this a silent number?  
Work Mobile
Email address
Best time to contact you

7. Is this the first time you have applied to CSA for collection of the payments?
        If yes, CSA reference number The CSA reference number may also be your Tax File Number.

8. Details of the bank account you want your child support paid into
Name of bank, building society or
credit union
Branch where your account is held
Branch (BSB) number   Account number  
Account name

9. Do you have a Centrelink customer reference number?
     Your Centrelink customer reference number

10. Do you have a Tax File Number?
     Your Tax File Number    It is not an offence if you choose not to quote your Tax File Number.

About the person who is to pay the maintenance

11. Name of the person who is to pay you
Title
Surname
Given names
Date of birth
Address
Phone number
Mobile

12. Does this person get a salary or wage from an employer? (So we can deduct the payments from their pay)

If yes, employer‘s name
Address

About the court order or agreement


13. Do you have a copy of the court order or agreement?

If yes, please attach photocopies of the latest order or agreement and any earlier orders or agreements which still apply.

If No, please give details about the latest order or agreement:

Location of the court where the order or agreement was made
Type of court (e.g. Family, Magistrates)
Date of the order or agreement
From what date is the maintenance payable?
Is it:    

14. Children in the order or agreement whose maintenance you want CSA to collect for you
Given name of each child Date of birth Amount payable under the order/agreement
$ per
$ per
$ per
$ per
$ per

15. Did the children‘s parents live together?
    If yes, give date of separation
Write ‘not separated’ if still living together in a domestic relationship

16. Does the order or agreement include spouse maintenance for collection by CSA?
   If yes, state amount of maintenance payable $ per 

17. Is the maintenance currently payable through court or state collection agency?   If yes, name and address of the court or agency

18. Has the payer paid any maintenance in the last month? So the payer can be allowed credit for the payments

If yes, amount paid through a court or collection agency $
Amount paid to you or to someone else for the benefit of the children (or for your benefit if spouse maintenance is payable) $
Period the payments cover  to 

I declare that to the best of my knowledge the information
I have given is complete and correct. There are penalties for deliberately giving false or misleading informaiton.

Date

Your privacy
The information requested by CSA is needed for child support purposes and is required by child support law. We do not pass your personal information on to the other parent, except where this is required by law or necessary to make a decision that would affect the other parent.

Some information may be passed to Centrelink, the Australian Taxation Office or to a law enforcement agency. We do not collect information for commercial marketing. We will not pass on your information to any private organisation, except we may provide your contact details to organisations contracted by CSA to carry out research to help CSA improve its services. You are not obliged to participate in this research.

CSA‘s guidelines on privacy are in accordance with the Information Privacy Principles of the Privacy Act 1988. For more information about the Privacy Act and privacy generally, see the Privacy Commissioner‘s website at www.privacy.gov.au. For more information about CSA‘s collection, use and disclosure of information, see The Guide.

CSA cannot guarantee the security of personal information sent via the Internet.


Send this form to a CSA office
NSW Sydney GPO Box 9815 Sydney 2001
         
VIC/TAS Melbourne GPO Box 9815 Melbourne 3001
         
QLD Brisbane GPO Box 9815 Brisbane 4001
         
SA/NT Adelaide GPO Box 9815 Adelaide 5001
         
WA Perth PO Box 9815 Perth 6848

Need help to complete this form?
Telephone CSA on 131 272 (local call charge excluding mobile and public phones).

If you have a complaint