Hague Convention - Form 1
Form 1
Application in Accordance with the Hague Convention on the Civil Aspects of International Child Abductionfor the Return of a Child Abducted from New Zealand
Section 9(1), Guardianship Amendment Act 1991
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This application concerns the following child: ................................................... [Insert full name of child to whom application relates], who will attain the age of 16 years on ................ 19 ......
NOTE: The following particulars should be completed in full where possible.
I. IDENTITY OF THE CHILD AND ITS PARENTS:
1. Child
Name and first names:
Date and place of birth:
Habitual residence before removal or retention:
Passport number or identity card number, if any:
Description (and attach a photograph, if possible):
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2. Parents
(a) Mother: Name and first names:
Date and place of birth:
Nationality:
Occupation:
Habitual residence:
Address:
Passport number or identity card number, if any:
(b) Father: Name and first names:
Date and place of birth:
Nationality:
Occupation:
Habitual residence:
Address:
Passport number or identity card number, if any:
(c) Date and place of marriage*:
* If never married, state "Not married".
II--REQUESTING INDIVIDUAL OR INSTITUTION (who actually exercised custody before the removal or retention):
Name and first names:
Date and place of birth:
Nationality of individual applicant:
Occupation individual applicant:
Address:
Passport number or identity card number, if any:
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Relationship to the child:
Name and address of legal adviser, if any:
III--PLACE WHERE THE CHILD IS THOUGHT TO BE:
Information concerning the person alleged to have removed or retained the child:
1. Name and first names:
2. Date and place of birth, if known:
3. Nationality, if known:
4. Occupation:
5. Last known address:
6. Passport number or identity card number, if any:
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Description (and attach a photograph, if possible):
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Address of the child:
- Other persons who might be able to supply additional information relating to the whereabouts of the child:
- [Give full name and address, if possible.]
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IV--TIME, PLACE, DATE, AND CIRCUMSTANCES OF THE WRONGFUL REMOVAL OR RETENTION:
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V--FACTUAL OR LEGAL GROUNDS JUSTIFYING THE REQUEST:
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VI--CIVIL PROCEEDINGS IN PROGRESS:
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VII--CHILD IS TO BE RETURNED TO:
- Name and first names
1. Date and place of birth:
2. Address:
3. Telephone number:
4. Proposed arrangements for return of the child:
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VIII--OTHER REMARKS:
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IX--LIST OF DOCUMENTS ATTACHED:
The following documents are attached:
* (a) Certified copy of relevant decision or agreement concerning custody or access:
* (b) Certificate or affidavit as to the applicable law:
* (c) Information relating to the social background of the child:
* (d) Authorisation empowering the Central Authority to act on behalf of the applicant:
* (e) Photograph of the child:
* (f) Photograph of the person alleged to have removed or retained the child:
* (g) Other (specify).
* Delete whichever is not applicable.
Date: ..................................................
Place: ................................................
Signature (or stamp, or both) of the requesting Central Authority or applicant.
