If you have served a petition for civil partnership dissolution or separation on your civil partner on the ground of a 5-year separation, and they have agreed not to contest the petition, use this document to draw up a statement confirming the details of the petition. You must sign the statement and file it with the court. A district judge will then decide whether or not to grant the dissolution/separation order. If you have not yet completed the document 'Form D84: Application for decree nisi/judicial separation decree', you should do so now. Please note that this document is only for use in England & Wales.