Annexure to Proposed Consent Parenting Order (Current Case) 
Federal Circuit and Family Court of Australia (Family Law) Rules 2021- Rules 5.29(6)(a) and (c) and 10.05(6)(a) and (d)	
Please type or print clearly and mark [X] all boxes that apply.  
Attach extra pages if you need more space to answer any questions.
Instructions:
•	If you are seeking final or interim parenting orders to be made by consent, each party to the application or their lawyer must complete and file a separate copy of this annexure, unless otherwise advised by the Court.
•	Attach the annexures to the back of the original of the proposed consent orders signed by the parties before filing.	COURT USE ONLY	

Client ID
      
File number      
Filed on      	

•	Part B must be completed by the person who signs the annexure.
•	Part C is only completed where there have been allegations of abuse, neglect or family violence or allegations of risk of abuse, neglect or family violence.
NOTE: A Notice of child abuse, family violence or risk must also be filed by each party when filing an Initiating Application or Response to Initiating Application seeking parenting orders, OR where new allegations of child abuse or family violence have been made after filing an Initiating Application or Response to Initiating Application.	
Part A	About the lawyer/party completing this form	
APPLICANT Name	

     	

	RESPONDENT Name	

     	

Complete one section only.	
 I am the lawyer for the:	          OR
 Applicant
 Respondent 
 Other party (specify) 	 I am the:
 Applicant
 Respondent 
 Other party (specify) 	
     		     	
			
Part B	Allegations or concerns about child abuse or family violence	
I	Whether a child has been or is at risk of abuse, neglect or family violence 
I certify that I, or the party I represent:
	declare that no allegations of risk of abuse, neglect or family violence in relation to a child concerned in the proposed order have been made in:
•	any document filed or exhibited in the proceedings; or
•	any report prepared for the proceedings; or
•	any document subpoenaed to the court in the proceedings.
	consider that a child concerned in the proposed order is not at risk of being subjected to or exposed to abuse, neglect or family violence. 
	consider that a child concerned in the proposed order is no longer at risk of being subjected to or exposed to abuse, neglect or family violence, AND all risk issues have been adequately addressed, as set out in Part C herein. 
	consider that a child concerned in the proposed order is at risk of being subjected to or exposed to abuse, neglect or family violence, AND all risk issues have been adequately addressed, as set out in Part C herein.
II	Whether a party has been or is at risk of family violence 
I certify that I, or the party I represent:
	declare that no allegations of risk of abuse, neglect or family violence in relation to a party concerned in the proposed order have been made in:
•	any document filed or exhibited in the proceedings; or
•	any report prepared for the proceedings; or
•	any document subpoenaed to the court in the proceedings.
	consider that a party concerned in the proposed order is not at risk of being subjected to or exposed to family violence. 
	consider that a party concerned in the proposed order is no longer at risk of being subjected to or exposed to family violence, AND all risk issues have been adequately addressed, as set out in Part C herein.
 	consider that a party concerned in the proposed order is at risk of being subjected to or exposed to family violence, AND all risk issues have been adequately addressed, as set out in Part C herein.	
NOTE: Unless you have ticked that there are no allegations of risk at both I and II above, you must complete Part B, III and Part C of this form.	
III	Allegations of risk of abuse, neglect or family violence
(a)	Child abuse or neglect, or risk of child abuse or neglect		 Yes     No
(b)	Family violence or risk of family violence				 Yes     No
(c)	Mental ill-health							 Yes     No
(d)	Drug or alcohol abuse							 Yes     No
(e)	Serious parental incapacity						 Yes     No
(f)	Any other allegation involving risk to the child or children		 Yes     No
have been made in:	
 Document/s filed or exhibited in the proceedings	
Title of document	Date filed/tendered and exhibit number	Page/paragraph number(s)	
     	     	     	
     	     	     	
 Report/s prepared for the proceedings	
Title of report	Author	Date filed or if not filed, date of the report and where a copy can be located	Page/paragraph number(s)	
     	     	     	     	
     	     	     	     	

 Documents subpoenaed to the Court in the proceedings	
Title of document	Details of who produced the document	Any document reference that may assist in locating the document/page/paragraph number(s)	
     	     	     	
     	     	     	

Part C	Explanation	
State briefly in numbered paragraphs how the allegations and risk issues contained in the above documents have been addressed:	
1.      	
     	
     	
     	
     	
Signed		Date	
	     /     /     	
Name 		
     		

Approved by the Chief Justice/Chief Judge pursuant to Rule 15.21	1122V2