Separation Agreement Questionnaire


Separation Agreement Questionnaire is one that provides the terms and conditions which govern the separation of a couple. This is a legal document that discusses all the terms and conditions agreed by both the parties. This questionnaire helps to identify the opinion of the couple regarding the separation agreement and also obtain valuable inputs to modify the same for the mutual benefit of the couples. Check the given below sample of Separation Agreement Questionnaire in order to understand the format of this questionnaire in a better manner.

Sample Separation Agreement Questionnaire

Name of the Husband                   __________________________________

Name of the Wife                            __________________________________

Complete Address                         __________________________________

Number of Children                      __________________________________

Social Security Number                __________________________________

Date of  Marriage                             __________________________________

Place of Marriage                           __________________________________

Reason for Separation                  __________________________________

Q1) What was your experience with this marriage?

a. Unsatisfactory

b. Average

c. Good

d. Excellent

Q2) What is the primary reason behind the decision of separation?

_____________________________________________________________________

Q3) Are you satisfied with the terms and conditions which are mentioned in the separation agreement?

a. Yes very much satisfied

b. Somewhat

c. Not much

d. No not at all satisfied

Q4) Are you happy on the compensation you would be receiving for managing the custody of your children?

_____________________________________________________________________

Q5) Are you willing to let your children meet your ex-spouse on some special occasions, or on the dates decided by this separation agreement?

_____________________________________________________________________

Q6) Please provide a rating for the terms and conditions mentioned in the agreement?

a. Unsatisfactory

b. Average

c. Good

d. Excellent

Q7) Will you be ready to make any future modifications in the child support system?

_____________________________________________________________________

Q8) Who manages and maintains the health insurance for the children and what is the monthly installment for that insurance?

_____________________________________________________________________

Q9) Should there be an escalator clause regarding the support amount increase added to this agreement?

a. Yes

b. No

Category: Social Questionnaire

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