HTML Preview Legal Child Support Agreement page number 1.
Child
Support
Agreement
Office Use Only
102
LP TFN
CP TFN
Eligibility (Y/N)
CP DSS Payment (Y/N)
CSA Collection (Y/N)
When to use this form
• To make a child support Agreement
• To lodge a child support Agreement with CSA
• To replace an existing child support Agreement
• To end an existing child support Agreement
IMPORTANT • A child support Agreement is a binding contract between the 2 parents.
It can only be changed by another Agreement or by going to court.
• If the payee receives more than the minimum rate of Family Tax Benefit, you must have a CSA
assessment and your Agreement must be at least the same amount as the assessment.
Keep a copy of the Agreement for your own records.
The Agreement (questions 21-41) must be signed by both parties and any changes must be initialled.
Please write neatly in BLOCK LETTERS Tick where applicable
✓
How to complete this form
Step 1 Read the information notes at the end of this form. If you have any
questions please contact CSA on 131 272.
Step 2 Either complete The Agreement on this form (pink section), or attach
a copy of a written Agreement signed by both parties.
Step 3 If possible the payee should complete and sign the section called
Information from the payee (blue section).
Step 4 Complete the Application for Acceptance of the Agreement
(green section) so CSA can register your Agreement. Either party to
the Agreement can complete this section.
Are you the payee (person who will receive the child support)?
Are you the payer (person who will pay the child support)?
do not complete Questions 16 to 20
1
About the person applying for the Agreement to be accepted
Application for acceptance of the Agreement
CSA 1666-04.04
2
Surname
Given names
Your postal address
3
Postcode
Your home address
4
(if different to your postal address)
Postcode
Title
Your name
Mr Mrs Miss Ms
Other
Your telephone
numbers
5
Home
(STD )
Work
(STD )
Mobile
Is this a silent number? Yes No
Email address
Best time to contact you?
Date of Receipt
LP Surname
Case Number