Form 56A.28A

(rule 56A.28)
In the Supreme Court of Newfoundland and Labrador Trial Division (General / Family)

Court No.  	
Court File No.  	
Central Divorce Registry No. 	(if applicable)

BETWEEN:	 	APPLICANT

AND:	 	RESPONDENT

Agreement as to Child Support

The parties agree as follows:

1.	The income of the payor [name] 	is $	.

2.	The payor currently resides in [province or, if resident outside of Canada, country]
 	.

3.	The income of the recipient [name] 	is $	.

4.	The recipient currently resides in [province or, if resident outside of Canada, country]
 	.

(Paragraphs 3 and 4 shall be included where special or extraordinary expenses are to be shared or where the amount agreed to differs from the table amount set out in the Federal Child Support Guidelines.)
5.	Child support is to be provided for [state names and dates of birth of children for whom child support is to be provided]:  	

and according to the applicable child support table set out in the Federal Child Support Guidelines, the amount of child support payable for that number of children (the "child support table amount") is $ 	.
6.	The payor shall pay to the recipient, [name] 	, child support of $ 	per month for the children referred to in section 5.
7.	[If applicable] The amount of child support agreed upon by this agreement differs from the child support table amount because: [state reasons]  	

8.	[If there are expenses under section 7 of the Federal or Provincial Child Support Guidelines to be shared] There are special or extraordinary expenses, being [state type of expense] 	on behalf of [name child]
 	 in the amount of $ 	per month, and the payor’s share of this expense is $ 		per month.
9.	All amounts owing under this Order shall be paid directly to the Director of Support Enforcement for the benefit of the child[ren] of the marriage at: Support Enforcement Agency,
P. O. Box 2006, Corner Brook, NL A2H 6J8, and this Order shall be enforced by the Director of Support Enforcement under the Support Orders Enforcement Act or any successor Act unless the Order is withdrawn from the Director in accordance with the Support Orders Enforcement Act or any successor Act.

DATED at 	, Newfoundland and Labrador , this  	
day of 	, 20 	.

Signature of Applicant or Applicant’s
Lawyer

DATED at 	, Newfoundland and Labrador , this  	
day of 	, 20 	.

Signature of Respondent or Respondent’s
Lawyer

This Form shall be filed with the court along with the following documents:
(a)	a copy of the most recent personal income tax return filed by the payor along with a copy of the most recent income tax assessment or reassessment, or an affidavit explaining why the documents are not available and providing evidence to satisfy the

court that the amount of income of the payor and child support agreed to by the parties is reasonable,
(b)	where special or extraordinary expenses are to be shared or where the amount agreed to differs from the table amount set out in the Federal Child Support Guidelines, a copy of the most recent personal income tax return filed by the recipient along with a copy of the most recent income tax assessment or reassessment, or an affidavit explaining why the documents are not available and providing evidence to satisfy the court of the amount of income of the recipient.