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Statutory declaration


CSA 2474-07.2006
PAYEE
This form is to be completed by the parent who is to receive child support payments

This form can not be submitted online.

When an application for a child support assessment is made for a child who was born while the parents were not married, CSA requires proof that the person who is to pay the child support is the child's parent.

One way of providing proof is for you to declare in this form that the person who is to pay child support is named in a register of births as parent of the child.

I, (full name of person
making declaration)
of (address)
State   Postcode  
(occupation)
 
do solemnly and sincerely declare that the person from whom I am seeking payment of child support is named in a register of births as parent of each child named here.
Surname

 Given names

 Place of birth
(i.e. NSW, Australia)
 Date of birth

(dd/mm/yyyy)

Full name of person from whom child support is being sought


And I make this solemn declaration by virtue of the Statutory Declarations Act 1959, and subject to the penalties provided by that Act for the making of false statements in statutory declarations, conscientiously believing the statements contained in this declaration to be true in every particular.
Signature of the person making this declaration
Your signature must be witnessed by an authorised person who then signs below. See below for a list of authorised persons.
Declared at
on the  day of 20

Before me
Signature of person before whom the declaration is made
Full name, qualification and address of person before whom the declaration is made (in printed letters:
Full name
Qualification
Address
State   Postcode  

Information notes

Penalty for false statement

A person who deliberately makes a false statement in a statutory declaration under the Statutory Declarations Act is guilty of an offence under this Act. If the offence is prosecuted on indictment, the penalty is imprisonment for a term not exceeding 4 years.

Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959—see section 5A of the Statutory Declarations Act 1959.

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 Centrelink,the Australian Taxation Office or to a law enforcement officer.

Where to send this form

Please 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.

Child Support Agency Offices:

NSW/ACT 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).

For more information about CSA

  • visit our Web site at www.csa.gov.au
  • ask about our Fact Sheets.

If you have a complaint

  • please contact us on 131 272 (local call charge excluding mobile and public phones).
  • if you are still not satisified call the Complaints Service on 132 919.

The Australian Government Services Fraud tip-off line

The Australian Government Services Fraud tip-off line provides people with a place to report suspected fraud against Centrelink, Medicare, the Parmaceuticals Benefits Scheme or the Child Support Agency. If you have information about someone who is misusing government services, call 13 15 24.

A statutory declaration under the Statutory Declarations Act 1959 may be made before—

(1) a person who is currently licensed or registered under a law to practise in one of the following occupations:

Chiropractor
Medical practitioner
Patent attorney
Psychologist
Dentist
Nurse
Pharmacist
Trade marks attorney
Legal practitioner
Optometrist
Physiotherapist
Veterinary surgeon

(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); or

(3) a person who in the following list:

  • Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public
  • Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)
  • Bailiff
  • Bank officer with 5 or more continuous years of service
  • Building society officer with 5 or more continuous years of service
  • Chief executive officer of Commonwealth court
  • Clerk of a court
  • Commissioner for Affidavits
  • Commissioner for Declarations
  • Credit union officer with 5 or more continuous years of service
  • Employee of the Australian Trade Commission who is:
    1. in a country or place outside Australia; and
    2. authorised under paragraph 3(c) of the Consular Fees Act 1955; and
    3. exercising his or her function in that place
  • Employee of the Commonwealth who is:
    1. in a country or place outside Australia; and
    2. authorised under paragraph 3(c) of the Consular Fees Act 1955; and
    3. exercising his or her function in that place
  • Fellow of the National Tax Accountants' Association
  • Finance company officer with 5 or more continuous years of service
  • Holder of a statutory office not specific in another item in this list
  • Judge of a court
  • Justice of the Peace
  • Magistrate
  • Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act1961
  • Master of a court
  • Member of Chartered Secretaries Australia
  • Member of Engineers Australia, other than at the grade of student
  • Member of the Association of Taxation and Management Accountants
  • Member of the Australian Defence Force who is:
    1. an officer; or
    2. a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982 with 5 or more continuous years of service; or
    3. a warrant officer within the meaning of that Act
  • Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants
  • Member of:
    1. the Parliament of the Commonwealth; or
    2. The Parliament of a State; or
    3. a Territory legislature; or
    4. a local government authority of a State or Territory
  • Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961
  • Notary public
  • Permanent employee of the Australian Postal Corporation with 5 or more continuous years of service who is employed in an office supplying postal services to the public
  • Permanent employee of:
    1. the Commonwealth or a Commonwealth authority; or
    2. a State or Territory pr a State or Territory authority; or
    3. a local government authority;
    with 5 or more continuous years of service who is not specified in another item in this list
  • Person before whom a statutory declaration may be made under the law of the State of Territory in which the declaration is made
  • Police officer
  • Registrar, or Deputy Registrar, of a court
  • Senior Executive Service employee of:
    1. the Commonwealth or a Commonwealth authority; or
    2. a State or Territory or a State or Territory authority
  • Sheriff
  • Sheriff's officer
  • Teacher employed on a full-time basis at a school or tertiary institution