FM3
I have a maintenance order or court registered agreement and I choose not to have CSA collect the payments

CSA 1645-12.2004

This form can be submitted online.

When to use this form?
Do you have a maintenance order or maintenance agreement registered with a court and you do not want CSA to collect the payments for you? If so you must use this form.

Do not use this form if:

• you want to tell CSA of the order or agreement and you want CSA to collect payments for you (use form FM1)
• you have already told CSA of the order or agreement and now you want CSA to collect payments for you (use form AFC)
• you have already registered the order or agreement and your personal details have changed or there is a change that affects the amount of child support payable (use form CMD).

1. Your name

Title	Mr Mrs Miss Ms
Surname
Given names

2. Your postal address

State	NSW ACT VIC TAS SA WA NT QLD ---- Overseas country: ---- UK USA NZ Other country   Postcode

3. Your phone numbers

Home	Is this a silent number? Yes   No
Work	Mobile
Email address
Best time to contact you

4. Do you have a Centrelink customer reference number?

Yes   No     If yes, Centrelink customer reference number

5. Name of the person who has to pay you the maintenance

Title	Mr Mrs Miss Ms
Surname
Given names

6. The children named in the court order or court registered agreement whose maintenance you do not want CSA to collect for you

Given names of child	Date of birth	Amount payable as shown in order or agreement $ per
		$ per
		$ per
		$ per
		$ per
		$ per
		$ per

7. Spouse maintenance in the order or agreement you do not want collected for you

Amount of maintenance payable  per 

8. Details of the court where the order was made or the agreement was registered

Location of the court
Type of court (e.g. Family, Magistrates)
Date of the order or agreement (dd/mm/yyyy)
Is it: an order? consent order? agreement?

9. I choose not to have the above maintenance collected for me by CSA.

Please note: There are penalties for deliberately giving false or misleading information.

Date

Your privacy

The information requested in this form is needed for child support purposes and is required by child support law. Some information may be passed to the Australian Taxation Office, Centrelink, or to a law enforcement officer.

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

Ssend 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

• please contact us on 131 272.
• if you are still not satisified call the Complaints Service on 132 919.