Office Use Only
When to use this form
make a child support Agreement
lodge a child support Agreement with CSA
replace an existing child support Agreement
end an existing child support Agreement
Date of Receipt
How to complete this form
Read the information notes at the end of this form. If you have any
questions please contact CSA on 131 272.
Either complete The Agreement on this form (pink section), or attach
CP DSS Payment (Y/N)
a copy of a written Agreement signed by both parties.
CSA Collection (Y/N)
If possible the payee should complete and sign the section called
Information from the payee (blue section).
Complete the Application for Acceptance of the Agreement
(green section) so CSA can register your Agreement. Either party
the Agreement can complete this section.
• A child support Agreement is a binding contract between the