Application to Establish New Case File

Diocesan Clerical Council

for Marital Affairs

100 Park Road, Donvale, Victoria, Australia 3111
PO Box 1150, Mitcham North, Victoria, Australia 3132

Phone: +61 3 8872 8414
Email: dcc@melbcopts.org.au
Application to Establish New Case File

Use this form to apply to establish a case with the Clerical Council for Marital Affairs in the Coptic Orthodox Diocese of Melbourne.
Applicant Details:
Applicant is:*

HusbandWife
Full Name (as indicated on Australian identification documents)*

First NameMiddle Name(s)Last Name
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Mobile Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Date of Birth*

DayMonthYear
Occupation*
Church Attended*
Confession Father*
Type of Photo ID Document and Issuing Location*
e.g.: driver licence / passport (state, country)
ID Document (Please upload a copy of a valid Australian photo ID)*

Cancelof
Portrait Photo (please upload a recent portrait photo of you)*

Cancelof
Number of Previous Coptic Church Marriages (other than one subject of this application):

012More

Spouse Details:
Full Name (as indicated on Australian identification documents)*

First NameMiddle Name(s)Last Name
Address

Street Address

Street Address Line 2

SuburbState

Postcode
Mobile Phone Number

Area CodePhone Number
E-mail
example@example.com
Date of Birth*

DayMonthYear
Occupation
Church Attended
Confession Father
Type of Photo ID Document and Issuing Location
e.g.: driver licence / passport (state, country)
ID Document (Please upload a copy of a valid Australian photo ID)

Cancelof
Spouse Portrait Photo (please upload a recent portrait photo of spouse)

Cancelof
Number of Previous Coptic Church Marriages (other than one subject of this application):

012More

Marriage Details:
Date of Marriage*

DayMonthYear
Date
Church Where Ceremony Held*

Church Name

Street Address Line 2

City and StateState / Province

Postal / Zip CodeCountry
Church Marriage Certificate

Please upload a copy of the marriage Church certificate
Cancelof
Civil Marriage Certificate*

Please upload a copy of the marriage Civil certificate
Cancelof

Please List Children of this Marriage

Please provide names of Church priests to give reference on this case:

Please summarise below the reasons for the marriage breakdown and separation. It can be in English or Arabic.
Please upload any documents to support your application

Cancelof
Should be Empty: