Fixed Fee Divorce Questionnaire

1. Your Details

Full Name*

Despatch Address*

Email*

Confirm Email*

Contact Number*

How would you like to receive your Pack?*EmailPost

Date of Birth*

Occupation*

Divorce in England & Wales?*YesNo

2. Your Partner's Details

Full Name*

Despatch Address*

Date of Birth*

Occupation*

Has your Wife/Husband instructed solicitors to your knowledge?*YesNo

If YES, please provide details:

3. Other Information about the Marriage

Date of Separation*

Address at which you last lived together*

Reasons for Divorce (please tick which one applies) *see Fact Sheet for guidance—Please choose an option—AdulteryUnreasonable Behaviour2 Years separation with consent

If you have ticked Unreasonable Behaviour, please give 4 or 5 examples below.

If you have ticked 2 Years Separation with Consent. Please give details of the addresses where you and your husband/wife have lived since separation, and the relevant dates that you lived at these addresses.

Are there any other divorce proceedings relating to the marriage in any court in this country or elsewhere?YesNo

If YES, please provide details:

4. Children — Statement of Arrangements

Children Of The Family

Provide full details of all children born to either of you before, during or after the marriage and who are still living with the you.

Details of the Children & Living Arrangements:

• Child 1▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Child over 16, but under 18 and in education, training or working full timeYesNo

  Child of Both partiesYesNo

  Child of the family but NOT born to you e.g. stepchildrenYesNo

• Child 2▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Child over 16, but under 18 and in education, training or working full timeYesNo

  Child of Both partiesYesNo

  Child of the family but NOT born to you e.g. stepchildrenYesNo

• Child 3▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Child over 16, but under 18 and in education, training or working full timeYesNo

  Child of Both partiesYesNo

  Child of the family but NOT born to you e.g. stepchildrenYesNo

• Child 4▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Child over 16, but under 18 and in education, training or working full timeYesNo

  Child of Both partiesYesNo

  Child of the family but NOT born to you e.g. stepchildrenYesNo

• Child 5▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Child over 16, but under 18 and in education, training or working full timeYesNo

  Child of Both partiesYesNo

  Child of the family but NOT born to you e.g. stepchildrenYesNo

Children Of Either Party Who Are NOT Children Of The Family

Details of the Children & Living Arrangements:

• Child 1▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Born to or adopted by PetitionerYesNo

  Born to or adopted by RespondentYesNo

• Child 2▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Born to or adopted by PetitionerYesNo

  Born to or adopted by RespondentYesNo

• Child 3▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Born to or adopted by PetitionerYesNo

  Born to or adopted by RespondentYesNo

• Child 4▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Born to or adopted by PetitionerYesNo

  Born to or adopted by RespondentYesNo

• Child 5▲

  Full name of child

  GenderMF

  Date of Birth

  Resides with

  At Address

  Is this arrangement agreed by both parties? (if No, provide details)

  Born to or adopted by PetitionerYesNo

  Born to or adopted by RespondentYesNo

Health & Education Details (Children of the family only)

• Child 1▲

  Full name of child

  Generally in good health?YesNo

  If No, provide details

  Are there any special Health needs?YesNo

  If Yes, provide details of any serious disability, chronic illness or care needed and how it is to be provided

  Name of School, College or place of training

  Are there any special Education needs?YesNo

  (if yes, provide details)

• Child 2▲

  Full name of child

  Generally in good health?YesNo

  If No, provide details

  Are there any special Health needs?YesNo

  If Yes, provide details of any serious disability, chronic illness or care needed and how it is to be provided

  Name of School, College or place of training

  Are there any special Education needs?YesNo

  (if yes, provide details)

• Child 3▲

  Full name of child

  Generally in good health?YesNo

  If No, provide details

  Are there any special Health needs?YesNo

  If Yes, provide details of any serious disability, chronic illness or care needed and how it is to be provided

  Name of School, College or place of training

  Are there any special Education needs?YesNo

  (if yes, provide details)

• Child 4▲

  Full name of child

  Generally in good health?YesNo

  If No, provide details

  Are there any special Health needs?YesNo

  If Yes, provide details of any serious disability, chronic illness or care needed and how it is to be provided

  Name of School, College or place of training

  Are there any special Education needs?YesNo

  (if yes, provide details)

• Child 5▲

  Full name of child

  Generally in good health?YesNo

  If No, provide details

  Are there any special Health needs?YesNo

  If Yes, provide details of any serious disability, chronic illness or care needed and how it is to be provided

  Name of School, College or place of training

  Are there any special Education needs?YesNo

  (if yes, provide details)

What are the contact arrangements between the child(ren) and non-resident parent?

Have you (the Petitioner) and Respondent agreed to these contact arrangements?YesNo

If no, please give details:

Who Will care for the child(ren) on a day to day basis ?

Have you (the Petitioner) and Respondent agreed to who will care for the child(ren) on a daily basis?YesNo

If no, please give details:

If Contact Arrangements have NOT been agreed and there is a dispute, are you intending to:

Seek to resolve matters with the respondent directly?:YesNo

Propose the use of Alternative Dispute Resolution, such as mediation:YesNo

If NO, would you agree to do so?:YesNo

Make an application to the court?:YesNo

Does your Husband/Wife pay maintenance for the Children?YesNo

If YES:–

Was this voluntarily, or through the CSA?:VoluntarilyCSA

Please provide full details of the arrangement:

If No:–

Do you intend to make a claim through the CSA or Courts?:YesNo

Will there be any changes in the living arrangements as a result of the divorce?YesNo

Are any of the children in the care of the local authority, or under the supervision of a social worker or probation officer?YesNo

If YES, please provide details (please include information about any current proceedings in the youth or family court):

Are any of the children the subject of a Child Protection Plan?YesNo

If YES, please provide details (include name of local authority and the date of registration):

Are there, or have there been, any proceedings in any court involving the children, for example residence or contact proceedings, care of supervision, adoption or wardshipYesNo

If YES, please provide details (include name of local authority and the date of registration):

Are there, or have there been, any proceedings in any court which may have an impact on the children. E.g. non molestation orders, or criminal proceedings relating to domestic violence?YesNo

If YES, please provide details (include name of local authority and the date of registration):

5. Any Other Issues

Are there any other issues which you feel we should be aware of at this stage in your proposed divorce?

I am happy to receive newsletters and promotional information from Burton & Dyson

Please enter the text from the image*

If you would like to see full details of our data practices please visit our Privacy Policy and if you have any questions please email info@burtondyson.com.