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Circuit Court Rules

Schedule: B - forms

Form: 37Q Affidavit - in the matter of the Gender Recognition Act 2015

S.I. No. 84 of 2016
Form 37Q

AN CHÚIRT CHUARDA TEAGHLAIGH

THE CIRCUIT FAMILY COURT


CIRCUIT

COUNTY OF


IN THE MATTER OF THE GENDER RECOGNITION ACT 2015

AFFIDAVIT OF [Insert name of person swearing affidavit]

I, [Insert name of person swearing affidavit], of .......... being aged eighteen years and upwards, MAKE OATH and say as follows:

1. I am the next friend of [state name of child on whose behalf the application is made] (“the child”), who ordinarily resides at .......

2. I refer to the ex parte motion in these proceedings dated the ....... 20... and say that the facts as alleged in this affidavit are true and correct.

3. I beg to refer to the certificates of ..........., medical practitioner, and ........, *[endocrinologist] *[psychiatrist], upon which, marked with the letter “A”, I have signed my name prior to the swearing of this affidavit.

4. †As the child’s *[parents] *[surviving parent] *[surviving guardian], *[I/we] your deponent(s) consent to the making of this application on behalf of the child.

†The child’s *[parents] *[surviving parent] *[surviving guardian], *[are/*is] ....... of ....... *[and ....... of .......] and I further beg to refer to the affidavit(s) of the said ........ *[and ........], indicating consent to the application made in these proceedings.]

†The child’s *[parents] *[surviving parent] *[surviving guardian], *[are/*is] ....... of .......... *[and ....... of .........] and an application will be made to the Court to dispense with the consent of ......... on the grounds that

*the consent cannot be obtained because ...... cannot be identified or found

*the consent cannot be obtained because ...... is failing or neglecting to respond to a request for consent

*the consent should not be obtained because the nature of the relationship between the child and ........ shows that it would not be in the interest of the safety or welfare of the child to contact .........

The facts supporting the said application to dispense with consent are ..........

........... Deponent(s)

Sworn before me at ...........

in the County of........ this .... day of …... 20...

and *[I know the deponent/each of the deponents personally]

*[the deponent/each of the deponents having been identified to me by ........ of .......... who is personally known to me]

*[the identity of the deponent/each of the deponents having been established by me by reference to the following document (being a relevant document within the meaning of section 2 of the Statutory Declarations Act 1938), viz ...........]

..............

Commissioner for Oaths/Practising Solicitor

*Delete where appropriate

†Use only the option which is appropriate to the case and delete the other two