Application Form
Name
Address
Telephone Number and Email Address
Owned or Rented? Living with Parents ? Please describe resident ? 3 Bed Semi -Detatched etc
Folio No. if Property Owned? (see landdirect.ie email landdirect@prai.ie or Tel: 0761 001610 or 051303000
What is happening with the Family Home?
Respondents Name
Respondents Address
Owned or Rented? Living with Parents ? Please describe resident ? 3 Bed Detatched etc
Date of Marriage: (Month & Year)
/
Day
/
Month
Year
Date
Name & Address of Church/Wedding Venue
Children(s) Name(s) and DOB:
Are the children of the marriage and who do they live with?:
Children's School
Any special education needs?
Maintenance being Paid?
Access if any?
Children's Health (any special needs)
Applicant and Respondent in Good Health?
Children (Any court proceedings?) In care of Health Board ?
16 Children (Any court proceedings?) In care of Health Board?
Occupation of Applicant
Work Address of Applicant
Occupation of Respondent
Work Address of Respondent
Date of marriage breakup: (Day, Month & Year)
/
Day
/
Month
Year
Date
Date of separation agreement or annulment: (Day, Month & Year)
/
Day
/
Month
Year
Date
(Is it a judicial separation?)
Papers to be served to respondent by post or by hand?
Name of pension if any?
Policy No. and Date Started?
Payment on Death? Yes/No
Name & Address of Trustees
Contact: Tracey: 0876725988
email: info@nohasslediydivorces.com
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