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AFC
Application for collection of child support

You can tell CSA about the changes by phoning 131 272 CSA 1979-02.2005

This form can be submitted online.

Only use this form if you have ALREADY REGISTERED with the CSA and you now want the CSA to begin collecting the child support payments for you.

Do NOT use this form to apply for collection of child support payments if:

1. Your name
Title
Surname
Given names

2. Your former name if you have changed your name
Title
Surname
Given names
The name you want used in CSA letters   

3. Your postal address
 
State   Postcode  

4. Your home address
(if different to your postal address)
State   Postcode  

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

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

7. CSA reference number (as shown in correspondence to you)

8. Bank details
Name of bank, building society or credit union
Branch where your account is held
Branch (BSB) number
Account number
Account name
(you must be a party to the account)

9. Details of the person who is to pay you the child support
Surname
Given names
Address
(or information which
might help to locate
the person)
State   Postcode  
Phone number (if known)

10. Does this person receive a salary or wage?
Name and address of employer
Phone number (if known)

11. Children who are currently registered with CSA and whose child support payments you want CSA to collect
Name Date of Birth
(dd/mm/yyyy)		 For court order or court registered
agreement only - amount payable
$ 
$ 
$ 
$ 
$ 

12. Why do you want CSA to collect your child support?Please tick all boxes that apply to you
Note CSA may verify the information you provide with the paying parent. If CSA accepts your application for collection of child support, we will advise the paying parent of the reasons why we have done so.
Amount due Amount paid Date paid Period the payment covers
$ $ to
$ $ to
$ $ to
$ $ to
$ $ to
 
Amount due Amount paid Date paid Period the payment covers
$ $ to
$ $ to
$ $ to
$ $ to
$ $ to

If child support payments are owing for more than 3 months, please provide information on the exceptional circumstances that prevented you from applying for collection earlier.



Date

Declaration I declare that the information I have given on this form is complete and correct.
Please note There are penalties for deliberately giving false or misleading information.

Your privacy

The information requested by CSA is needed for child support purposes and is required by child support law. We don't 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. CSA may provide your contact details to people contracted by us to deliver services to separated parents, or carry out research to help improve our services. You are not obliged to participate in any programs or research.

Our 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 our collection, use and disclosure of information, see The Guide in the legal section of CSA's website at www.csa.gov.au.

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


Important Always keep records of your child support payments as you may need to supply this information to the CSA at a later date.

Where to send this form
Please use the submit button above or send this form to the address shown on CSA letters to you or send to the nearest CSA office.
Centrelink customers can lodge this form at a Centrelink Customer Service Centre.

CSA office addresses:

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