1998 Charter Appendix B: Agreement of Permanent Separation and Guardianship of Children

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APPENDIX B: AGREEMENT OF PERMANENT SEPARATION AND GUARDIANSHIP OF CHILDREN

(This form is for the purpose of officially dissolving a marriage and stating who will care for the children of the applicants, as is explained in the Permanent Marital Separation Rules of the "Fundamental Family Rules." Each party should retain a signed and notarized copy of this form, and the same should be sent to the continental office.)

Legal Name of Husband: _______________________
Nationality: __________________________________
Passport or ID Number: ________________________
Legal Name of Wife: __________________________
Nationality: __________________________________
Passport or ID Number ________________________

Children in care of Husband:

1) Name: ________________
Nationality: ____________ Passport or ID Number: __________

2) Name: ________________
Nationality: ____________ Passport or ID Number: __________

3) Name: ________________
Nationality: ____________ Passport or ID Number: __________

4) Name: ________________
Nationality: ____________ Passport or ID Number: __________

5) Name: ________________
Nationality: ____________ Passport or ID Number: __________

Children in care of Wife:

1) Name: ________________
Nationality: ____________ Passport or ID Number: __________

2) Name: ________________
Nationality: ____________ Passport or ID Number: __________

3) Name: ________________
Nationality: ____________ Passport or ID Number: ____________

4) Name: _______________
Nationality: ____________ Passport or ID Number: _____________

5) Name: _______________
Nationality: ____________ Passport or ID Number: _____________

Statements from Separating Couple:

I, _______________________, the husband of _______________________, agree to no longer live together with her as man and wife, or to impose any aspects of marriage upon each other. The children have been placed in each of our care according to mutual agreement and the best interests of all concerned.

Date: ___/___/___
Location:
Signature of Husband:

Signed in the presence of:

_______________________ _____________________
(Witness) (Witness)

I, _______________________, the wife of _______________________, agree to no longer live together with him as man and wife, or to impose any aspects of marriage upon each other. The children have been placed in each of our care according to mutual agreement and the best interests of all concerned.

Date: ___/___/___
Location:
Signature of Wife:

Signed in the presence of:

_______________________ _____________________
(Witness) (Witness)

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Source: Love Charter, pages 384-385, 1998.