Rule 2.48(1)
FORM 23S Form of agreement for parental order under Section 30(r) of the Human Fertilisation and Embryology Act 1990
in the
Petition
of
[A.B.](designation and address)
and
[C.D.](designation and address) [or serial number where one has been assigned]
for
A Parental Order under the Human Fertilisation and Embryology Act 1990
in respect of
[E.F.](nameas in birth certificate)
I, (name and address), being the father of the child by virtue of section 28 of the Human Fertilisation and Embryology Act 1990 [or otherwise] [or the woman who carried the child] hereby state
(1) That I understand that the effect of the parental order for which application has been made will be to deprive me permanently of parental rights and responsibilities relating to the child and to vest them in the petitioners; and, in particular, I understand that, if an order is made, I shall have no right to see or get in touch with the child or to have him [or her] returned to me.
(2) That I understand that the court cannot make a parental order in relation to the child without my agreement and the agreement of the woman who carried the child [or the father of the child, where he is not one of the petitioners] unless the court dispenses with an agreement on the ground that the person concerned cannot be found or is incapable of giving agreement.
(3) That I understand that when the hearing of the petition to determine the application for a parental order in relation to the child is heard, this document may be used as evidence of my agreement to the making of the order unless I inform the court that I no longer agree.
(4) That I freely, and with full understanding of what is involved, agree unconditionally to the making of a parental order in relation to the child.
(5) That I have not received or given any money or benefit, other than for expenses reasonably incurred, for or in consideration of
(a)the making of a parental order,
(b)the execution of this agreement,
(c)the handing over of the child to the petitioners, or
(d)the making of any arrangements with a view to the making of a parental order,
[other than [state any money or other benefit given or received by authority of the court and specify such authority)].
I have signed this agreement at (place of signing) on the day of.
(Signed by father of the child or woman who carried the child)
This agreement was signed by before me at on the day of
(Signed)
Reporting Officer
[or Witness
(full name and address)]