4 Other person with
Full name and current address of other person with parental responsibility:
Complete a separate form B-9
for each other person with
If applicable, former name(s) of other person with parental responsibility:
parental responsibility who
has not provided written
Relationship to the child:
Date of birth:
approximate age now:
Is this person an:
(circle one answer)
Has this person ever visited Australia? YES / NO
If YES, give approximate date(s):
What are the last contact details you have for this person?
(include postal, email or social media addresses, phone numbers, friends, relatives or employer’s addresses)
Have you tried to contact this person using any of these contacts? YES / NO
If YES, what was the result?
If NO, please give reasons:
5 Court orders affecting
If there are court orders affecting your or another person’s rights in relation to the child you must also complete
rights in relation to the
a Form B-7 and provide the original copies of all court orders.
6 Child support payments
Do you receive or make any Child Support payments in respect of this child? YES / NO
If YES, please provide details:
7 Contact between child
Describe the nature of the relationship between the child and this person (e.g. give details of the nature and
frequency of contact visits, phone calls, e-mails, text messages, etc.):
and other person with
When was the last contact between the child and this person?
What was its purpose?
Form B-9, March 2011
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