Financial Summary
(Priority Property Pools under $500,000)
Sections 79 and/or 90SM of the Family Law Act 1975	To be completed by the Court	
	Federal Circuit and Family Court of Australia
Family Court of Western Australia 
Other	
	File number	Date filed	
			
You must file this form if you:
•	file an application or response seeking the division of a property pool valued at $500,000 net or less, or 
•	you are directed by the Court to file this form. 		
Please read the Guide for Practitioners and Parties in Family Law Priority Property Pools under $500,000 cases and Family Law Practice Direction – Priority Property Pools under $500,000 before completing this form.	
Statement of Truth	
*[I believe] that the facts contained in this form are true. I understand that a Judge or Registrar of the Court and the other parties stated in this application will rely on the facts that I have provided in this application as being true.	
	Sign here		
	
Section 1: About you (the person completing this form)	
1.	Your full name	First Name	     	Last Name	     	
2.	Gender	 Male	 Female	 Other	
3.	Are you the	 Applicant	 Respondent	
4.	Email address	     	
The Court requires a personal email address for you.	
Section 2: Pre-court dispute resolution processes (mark one box)	
	The parties attended Family Dispute Resolution or mediation and reached agreement.	
	The parties attended Family Dispute Resolution or mediation and did not reach agreement.	
	The parties have undertaken another dispute resolution process.	
	The parties have not attempted any dispute resolution process.	

Section 3: Your relationship	
5.	Relationship (mark one box)	Defacto 	Married 	Divorced 	
6.	Date you started living together	Click here to enter a date.	
7.	Date of marriage (if applicable)	Click here to enter a date.	
8.	Date of final separation (if applicable)	Click here to enter a date.	
9.	Date of divorce (if applicable)	Click here to enter a date.	
	
De facto relationship (if you were married go to section 4)	
10.	Is the period or the total of the periods of the de facto relationship at least two years?	Choose an item.	
11.	Is there is a child of the de facto relationship?	Choose an item.	
12.	Have you made substantial contributions to the property so that a failure to make an order or declaration would result in serious injustice to you?	Choose an item.	
13.	Is, (or was) the relationship registered under a prescribed law of a State or Territory of Australia?	Choose an item.	
Section 4: Existing parenting orders, parenting plans or financial agreements	
14.	Have any orders or agreements been made about the children?		
	Date 	Type of Order	Current
Yes/No	Name of Court	
Order/ parenting plan/ agreement	Click here to enter a date.	Choose an item.	Choose an item.	     	
Order attached:	Choose an item.	
15.	Have you and the other party made a binding financial agreement or superannuation agreement about your property?		
	Date 	Type of Order	Current
Yes/No	Name of Court	
Order/ binding financial agreement	Click here to enter a date.	Choose an item.	Choose an item.	     	
Agreement attached:	Choose an item.	
16.	Are you or the other party bankrupt?		
	Date 	Type of Order	Current
Yes/No	Name of Court	
Order	Click here to enter a date.	Choose an item.	Choose an item.	     	
Order attached:	Choose an item.	
17.	Is there a proceeds of crime order or current forfeiture application underway? 	Choose an item.	

	
Section 5: Facts you rely upon	
The Court requires information to decide whether the final orders are just and equitable. If there are disputed facts, you may be required to provide an affidavit, documents or other evidence to support your case. 
Briefly describe the property you owned when you first lived together and its net value. Mark all that apply.	
Property	Description	Net value	
	House or unit	     	Value $     	
	Car	     	Value $     	
	Bank account	     	Value $     	
	Superannuation 	     	Value $     	
	Other describe	     	Value $     	
	
18.	Financial contributions (income) since the relationship started	
Set out a brief summary of your employment history from the time you commenced living with the other party.	
18.1 Your employer
(including periods you were self-employed or on government benefits)	Job title	Approximate dates	Annual income (estimated)	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
	
18.2 Other party’s employer
(including periods you were self-employed or on government benefits)	Job title	Approximate dates	Annual income (estimated)	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
     	     	Click here to enter a date. to Click here to enter a date.	$     	
	
19.	Lump sums received during the relationship or since it ended	
	Gift or inheritance	Amount received $     	Date Click here to enter a date.	
	Personal injury claim	Amount received $     	Date Click here to enter a date.	
	Redundancy	Amount received $     	Date Click here to enter a date.	
	Other describe	Amount received $     	Date Click here to enter a date.	
20.	Non-financial contributions during the relationship and since	
Did you or the other party make any non-financial contributions during your relationship, or since to acquire, maintain or improve property in the pool? (Mark the box that best describes the payment)	
	Use of own labour to improve a property (directly or indirectly).	
	Sourcing of materials at wholesale or below-market rates.	
	Design or decision-making for improvements to property.	
	Other (specify briefly):	     	
21.	Homemaker and parenting contributions during the relationship	
	Caring for children of the relationship		caring for step-children	
	Using income for food, clothing or household expenses		caring for grandchildren	
	Performing household tasks such as cooking, cleaning, washing, gardening to property		Other (specify briefly):       	
	
Section 6: Information about your personal circumstances	
Health	
22.	Do you or the other party suffer from any medical condition requiring ongoing supervision by a medical practitioner that affects your ability to work?	
Choose an item.	Condition	     	
	
Describe how the condition affects your ability to work:	     	
	
Living arrangements	
23.	Since separation, have you remarried, re-partnered or started to live with another person?	
Choose an item.	If yes: Name of partner	     	Click here to enter a date.	
Earning capacity	
24.	During cohabitation, did you or the other party undertake any course or training to increase (that person’s) earning capacity?	
Choose an item.	Describe	     	
25.	What is your highest education level? (Mark the box that best describes the qualification)	
	High school		Trade qual.		Diploma		Bachelor’s degree		Post-graduate	
	
6.1: Income and financial resources	
26.	Current employer’s	name:	     	
address:	     	
Your occupation (what you do)	     	
	Full-time		Part-time		Casual		Unemployed	

27.	Your income from all sources
You may include an estimate. If not applicable, write NIL.	
	Gross (before tax)	Net (after tax)	
Salary or wage
(including allowances)	$     	$     	
Business income
(including personal income derived from self-employment)	$     	$     	
Government payments
(including Centrelink and Department of Veteran’s Affairs income support payments. Include Family Tax Benefit and any payments from the National Disability Insurance Scheme)	$     	$     	
Interest and dividends
(including any income you receive from cash deposits, shares, managed investments)	$     	$     	
Rental property income	$     	$     	
Periodic payments by way of gift or allowances	$     	$     	
Reportable fringe benefits
Salary sacrifice or salary packaging includes any benefit received as part of earned income but not as a wage or salary (e.g. novated lease, use of a car as part of a salary package)	$     	$     	
Partnership distribution	$     	$     	
Trust distribution – Give the name of trust
     	$     	$     	
Other income (any other income not listed above)	$     	$     	
	
6.2: Weekly expenses and debts	
28.	Give details of the expenses paid by you
If your expenses are shared, only provide the amount of those expenses that are incurred by you. For example, you contribute half the cost of electricity, and the electricity bill averages $100 per month, your share will be $50. Do NOT include expenses that are related to the operation of a business, company or trust. 
NOTE: You will be required to produce documents to support these amounts and bring them with you to Court.	
Breakdown of your expenses	Estimated weekly expense
(if paid monthly or fortnightly work out a yearly amount and divide by 52)	Amount owing
(if amounts outstanding)	
Debts – give the minimum payment required	
Credit card(s)	$     	$     	
Overdraft(s)	$     	$     	
Mortgage repayment	$     	$     	
Personal loan(s)	$     	$     	
Investment loan(s)	$     	$     	
Other – Give details below (e.g. Centrelink taxation)	$     	$     	

Living costs	
Rent/board	$     	$     	
Rates (e.g. council, water)	$     	$     	
Food	$     	$     	
Clothing	$     	$     	
Personal	$     	$     	
Medical insurance/bills	$     	$     	
Education expenses	$     	$     	
Utilities	
Electricity	$     	$     	
Phone	$     	$     	
Internet	$     	$     	
Gas	$     	$     	
Transport	
Public transport fares	$     	$     	
Fuel	$     	$     	
Vehicle registration	$     	$     	
Insurance	$     	$     	
Other running expenses	$     	$     	
Other personal expenses – give details 	$     	$     	
TOTAL:	$     	$     	
	
Future financial lump sums	
29.	If you or the other party expect to receive money mark the box that best describes the situation.  	
	Personal injuries claim	Amount expected $     	Date expected: Click here to enter a date.	
	Court case	Amount expected $     	Date expected: Click here to enter a date.	
	Deceased estate	Amount expected $     	Date expected: Click here to enter a date.	
	Other describe	Amount expected $     	Date expected: Click here to enter a date.	

	
Section 7: Children of the relationship	
First name	Last name	Date of birth	Gender	Does the child live with you or the other party?	
Child 1	
     	     	Click here to enter a date.	 M	 F	 Other	Choose an item.	
Child 2	
     	     	Click here to enter a date.	 M	 F	 Other	Choose an item.	
Child 3	
     	     	Click here to enter a date.	 M	 F	 Other	Choose an item.	
Child 4	
     	     	Click here to enter a date.	 M	 F	 Other	Choose an item.	
Child 5	
     	     	Click here to enter a date.	 M	 F	 Other	Choose an item.	
	
Section 8: Arrangements for your child(ren)	
30.	Provide the information for each child under 18 years who is the subject of the application even if the child does not live with you.	
1.	Briefly describe how much time the child(ren) spends with you and the other party	     	
	
Briefly describe any changes in the living arrangements for the children likely over the long term	     	
31.	Do you receive child support pursuant to an assessment issued by the Child Support Agency (CSA) for the child(ren) named in the application?	
Choose an item.	Amount expected $     	

32.	Do you pay child support pursuant to an assessment issued by the CSA for the child(ren) named in the application?	
Choose an item.	Amount expected $     	
If you or the other parent support the child(ren) in another way, such as through the payment of school fees or other expenses, explain the current arrangements	     	
	
Section 9: Changes to property since separation	
33.	Has any property been sold or disposed of since separation?	
Choose an item.	Amount expected $     	
Provide details of any property sold or disposed of since separation including the value of the property and how the funds were used	     	
34.	Has any property been purchased or acquired since separation?	
Choose an item.	Amount expected $     	
Provide details of any property purchased or obtained since separation including the value of the property and source of funds	     	
	
Section 10: Any other facts or circumstances
This section is only for any information not already mentioned in this form.	
35.	Particulars of the other relevant facts and circumstances relevant to the property orders you want made.
You do not need to provide the exact date or give a full statement.	
     	

Section 11: Balance sheet
Details of property, superannuation and liabilities	
36.	List the property and superannuation owned by you and the other party (together or separately) and your debts (together or separately) as of today. If you cannot list all of the assets, superannuation and liabilities on this form, include a separate sheet if necessary.	
ASSETS	
Property	Ownership	Estimated value	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
Superannuation name of fund	Ownership	Estimated value	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
LIABILITIES	Ownership	Estimated value	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	
     	     	$     	

11.1: Summary of assets	
37.	Complete the totals as known. If there is unknown property, total up the estimated values of known property and add “+NK”. 	
Description	Estimated value	
Gross property (not including superannuation)	$     	
(Total liabilities)	($     )	
Net property (not including superannuation)	$     	
Total superannuation	$     	
Total Net (including superannuation)	$     	

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