Opt Out Form From Kit

ADVERTISEMENT

Maintenance Enforcement Program
Opt-Out Form
Department of Justice
Use this form if you DO NOT want our help to enforce a maintenance order or agreement registered with a court. If you change your mind,
you can enrol in the program at a later date.
1.
Give or confirm your personal information
Case #: _____________
Last Name:
_______________________________
Other last names used: __________________________
First name:
_____________________________________
Middle name: __________________________
Address:
___________________________________________________________________________________________
_____________________________________________________
Postal Code: __________________________
Home phone number: ________________________
Work phone number: ____________________
Cell phone number: ________________________
Date of birth (dd/mm/yyyy): _______________
2.
Declare your role in the maintenance order or agreement
Recipient: I am owed money under a maintenance order or agreement.
Payor: I owe money under a maintenance order or agreement.
3.
Sign the Opt-Out form
I do not want to be enrolled with the program.
I understand that the other person may enroll in the program. If that happens, I will need to participate in the program.
I understand that either of us may choose to enroll in the program at a later date. However, if I am the Recipient, I understand that if
arrears have accumulated, the program may choose not to enforce collection of money past due.
If I am the Payor, I agree to make payments directly to the recipient if the recipient does not enroll in the program.
I consent to the storage and use of my personal information within the rules set out in provincial privacy legislation.
Name (please print):
_______________________________________________________________________________________
Signature:
______________________________________________________ Date:
________________________________
4.
Return the form and attachments to
For   S taff   U se   O nly  
Attention: Central Enrollment Unit (CEU)
 
Nova Scotia Maintenance Enforcement Program
Authorized   S ignature:     _ _______________________________________  
PO Box 803
 
Halifax, Nova Scotia B3J 2V2
Date:    
_________________________________________________________  
Fax : 902-428-2166
Questions?
Call:
902-424-0050 (Metro Halifax) or toll free in NS 1-800-357-9248 (MEP automated information line) or
902-862-4275 (direct) or toll free in NS 1-855-322-0934 (Client Service line)
If you want specific information about your case, have your case identification number and personal identification number ready.
Email:
NSMEP@novascotia.ca
MEP Online:
 
 
Page 1 of 1
Opt-Out Form 02092014 V.01
 

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go