Form 15a - Change Information Form Page 2
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9Form 15A:
Change Information Form
(page 2)
Court file number
4. This order/agreement
has never been assigned
has been assigned to
the Ontario Ministry of Community and Social Services
Ontario Works in
(name of location)
the municipality of
(name)
other
(specify)
The details of the assignment are:
(Give date of assignment, indicate whether it is still in effect, add any other relevant
information known to you and attach a copy of the Confirmation of Assignment Form.)
5. The applicant and the respondent:
started living together on
(date)
were married on
(date)
never lived together
separated on
(date)
were divorced on
(date)
6. The following chart gives basic information about the child(ren) in this case:
(List all child(ren) involved in this case, even those for whom no support is being claimed.)
Support
Now living with
Child’s full
Birthdate
Lives in
claimed
Age
(name of person and
legal name
(d, m, y)
(municipality & province)
for child?
relationship to child)
(YES or NO)
court order
agreement
7. I attach a copy of the existing
that contains the term(s) to be changed.
FLR-15A-E (2016/04)
Page 2 of 9
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