From 49.83-B 
 
Form of certificate relating to the cancellation or ceasing to have effect of a maintenance assessment under the Child Support Act 1991 
 
I, Deputy Principal Clerk of Session, certify that notification has been received from the Secretary of State under section 10 of the Child Support Act 1991 that the  maintenance assessment made on (date) has been cancelled [or ceased to have effect] on (date). 
 
 (Signed) 
 
 Deputy Principal Clerk of Session 
 
Date: