C-25, r. 5 - Regulation respecting the statement by parties in respect of applications relating to an obligation of support

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Updated to 1 September 2012
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chapter C-25, r. 5
Regulation respecting the statement by parties in respect of applications relating to an obligation of support
Code of Civil Procedure
(chapter C-25, art. 827.5).
1. The sworn statement required from each of the parties in article 827.5 of the Code of Civil Procedure (chapter C-25) is the statement in Schedule 1; it shall contain the information contained therein in respect of each party.
O.C. 1524-95, s. 1.
2. (Omitted).
O.C. 1524-95, s. 2.
CANADA
Province of Québec
District of
SWORN STATEMENT UNDER ARTICLE 827.5 OF THE CODE OF CIVIL PROCEDURE
File No.:
(Please complete in block letters)
IDENTITY: Applicant ( ) Defendant ( )
(1) Surname(s):
Given name(s):
(2) Surname at birth:
(3) Sex: M ( ) F ( )
(4) Language: French ( ) English ( )
(5) Residential address:
Postal code: Province: Country:
Telephone at home: ( ) At work: ( )
Postal address (if different):
Postal code: Province: Country:
(6) Date of birth (YYYY/MM/DD):
Social insurance number:
INFORMATION ON EMPLOYMENT AND INCOME
(7) Employee Self-employed worker:
Name and address of employer:
Postal code: Province: Country:
Remuneration:
Language of communication: French ( ) English ( )
(8) The deponent is unemployed: ( )
(9) The deponent receives income security benefits: ( ) File no. (CP 12):
(10) Other income:
(Indicate the source and amount of each)
OTHER INFORMATION
(11) Name at birth of deponent’s mother:
(12) Other name(s) used by the deponent:
(13) Indicate the nature and date of the application to which this statement is attached:
(14) If this statement is attached to an application for revision of support, indicate the date of the judgment awarding support (YYYY/MM/DD) and the file No., if different:
INFORMATION ON OTHER PARTY
(if it is known)
(15) Residential address:
(16) Telephone at home: At work:
(17) Date of birth: Social insurance number:
SWORN STATEMENT
I declare that the information given is true and complete, and I have signed:
At: on this day of
____________________________________________________
Deponent
Sworn before me at on this day of
____________________________________________________
Person authorized to administer oath
SJ-766 (06-96)
O.C. 1524-95, Sch. I; O.C. 212-97, s. 1.
REFERENCES
O.C. 1524-95, 1995 G.O. 2, 3331
O.C. 212-97, 1997 G.O. 2, 947