No:

In the District Court at [place]

Applicant: [give full name, *address, and occupation]

Respondent: [give full name, address, and occupation]

*Associated respondent: [give full name, address, and occupation]

Rules 22 and 45 of the Domestic Violence Rules 1996 permit the applicant's residential address to be omitted from this heading if he/she wants the address to be kept confidential from the respondent or associated respondent.

Section 7 (or section 52 or section 56 or section 62 or section 66), Domestic Violence Act 1995

Applicant: [full name]

Respondent: [full name]

*Associated respondent: [full name]

I, [full name], apply (*without notice) for a protection order against [full name], the respondent.

Note: A protection order automatically protects children of the applicant's family.

I also seek a direction that the protection order apply for the benefit of [full name].

I also seek a direction that the protection order apply against [full name], the associated respondent.

I request that the following special conditions be part of the protection order: [set out in sufficient detail the nature of the special conditions sought, eg a condition specifying a person who, for the purposes of sections 19(2), 20, and 28, is entitled to consent on behalf of a protected person].

This request may be made only where the application is on notice

I seek—

• *(a) a direction that the standard condition relating to weapons not be a condition of the protection order; or

• *(b) modification of the terms of the standard condition relating to weapons, as follows: [specify the modifications sought].

I request the Registrar to authorise the provision of a programme to the following person(s): [full name(s)].

*I apply (*without notice) for an occupation order granting me the right to personally occupy the dwellinghouse situated at [full address] (*for a period of ....... [state if order sought for specific period]).

*I request that the occupation order be made on the following terms and conditions: [specify any terms and conditions sought].

*I apply (*without notice) for a tenancy order vesting in me the tenancy of the dwellinghouse situated at [full address].

I apply for an ancillary furniture order granting me the possession and use of—

• *(a) all of the furniture, household appliances, and household effects in the dwellinghouse situated at [full address]; or

• *(b) the following furniture, household appliances, and household effects in the dwellinghouse situated at [full address]: [specify the items. It is not necessary to specify every item as long as the items in respect of which the application is made are readily ascertainable]—

*for a period of ....... [state if order sought for a specific period].

*I request that the ancillary furniture order be made on the following terms and conditions: [specify any terms and conditions sought].

I apply (*without notice) for a furniture order granting me the possession and use of—

• *(a) all of the furniture, household appliances, and household effects in the dwellinghouse situated at [full address]; or

• *(b) the following furniture, household appliances, and household effects in the dwellinghouse situated at [full address]: [specify the items. It is not necessary to specify every item as long as the items in respect of which the application is made are readily ascertainable]—

*for a period of ....... [state if order sought for a specific period].

*I request that the furniture order be made on the following terms and conditions: [specify any terms and conditions sought].

I rely on the content of the affidavit dated [specify date] filed in support of *this application/*these applications.

The parties to this application were (*the parties) (*some of the parties) to a previous application—

• *(a) under the Domestic Violence Act 1995; or

• *(b) under [specify previous enactment corresponding to Domestic Violence Act 1995]; or

• *(c) to which the Family Proceedings Rules 1981 apply,—

and that previous application was filed in a court other than the court in which this application is filed.

*The file number of that previous application is [specify].

or

*[State other information that may assist in identifying the file].

*The previous application was filed in the [name of court] Court at [place]

*I request that all documents relating to the previous application be transferred to the court in which this application is filed.

Complete if applying without notice for a protection order or a property order, or both, and the application is not intended to be made by the applicant in person.

I certify—

• (a) that I have advised the applicant that every affidavit that accompanies this application must fully and frankly disclose all relevant circumstances, whether or not they are advantageous to the applicant and any other person for whose benefit the order is sought; and

• (b) that I have made reasonable enquiries of the applicant to establish whether the relevant circumstances have been disclosed, and to the best of my knowledge every affidavit filed in support of this application discloses all such circumstances; and

• (c) that I am satisfied—

  • (i) that the application and every such affidavit comply with the requirements of the Domestic Violence Act 1995 and the Domestic Violence Rules 1996; and

  • (ii) that (*the order sought is one that ought to be made) (*that the orders sought are orders that ought to be made).

The Registrar is to complete the following appointment for hearing—

• (a) if the application is made on notice; or

• (b) if, in the case of an application without notice, an appearance is necessary or required.

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing of *this application/*these applications.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

A completed information sheet (form FP 7) must accompany this application. An applicant may request that his/her residential address be kept confidential. See rule 22 of the Domestic Violence Rules 1996.

An affidavit in form DV 3 must be filed with this application.

If applying for a protection order, a notice in form DV 5 must be filed with this application.

A person may be appointed by the court to make this application on behalf of another person (including a minor under the age of 17 years). See sections 9, 11, 12, and 73 of the Domestic Violence Act 1995.

• Schedule 1 form DV 2: amended, on 26 April 2005, by section 12 of the Relationships (Statutory References) Act 2005 (2005 No 3).

• Schedule 1 form DV 2: amended, on 1 March 1997, by rule 3 of the Domestic Violence Amendment Rules 1997 (SR 1997/10).

Domestic Violence Act 1995

Applicant: [full name]

Respondent: [full name]

*Associated respondent: [full name]

I, [full name], of *[place of residence], [occupation], *swear/*affirm:

• 1 I am the applicant in these proceedings.

• 2 I (*am) (*have been) in a domestic relationship with [full name], the respondent.

• 3 The nature of my domestic relationship with the respondent is as follows: [state sufficient facts to indicate the nature of the domestic relationship with the respondent (ie, whether a present or former spouse or partner, family or household member, a close personal relationship), and its duration (if applicable)].

Complete paragraphs 4–16 (where applicable) if applying for protection order

• *4 The respondent has used domestic violence against (*me) (*a child of my family) as follows: [state sufficient facts to indicate the nature and history of the domestic violence, including—

  • (a) an outline of the current situation or most recent incident:

  • (b) an outline of any behaviour that forms part of a pattern of behaviour from which protection is needed:

  • (c) details of any contact with Police, visits to a doctor or hospital].

• *5 The respondent—

  • *(a) holds a firearms licence:

  • *(b) possesses, or has under his/her control, weapons (as defined in the Domestic Violence Act 1995).

or

• *5 The respondent does not—

  • *(a) hold a firearms licence:

  • *(b) possess, or have under his/her control, weapons (as defined in the Domestic Violence Act 1995).

or

• *5 I do not know whether the respondent—

  • *(a) holds a firearms licence:

  • *(b) possesses, or has under his/her control, weapons (as defined in the Domestic Violence Act 1995).

Note: The Domestic Violence Act 1995 defines a weapon as any firearm, airgun, pistol, restricted weapon, ammunition, or explosive, as those terms are defined in the Arms Act 1983.

Complete paragraph 6 if applying for special conditions

• *6 The special conditions that I have requested be part of the protection order are necessary (*to protect me) (*to protect [state the names of the persons who would be protected by the protection order sought]) from further domestic violence, for the following reasons: [state sufficient facts to show why the special conditions are necessary for the protection of the applicant or others who will be covered by the protection order].

Complete paragraphs 7–12 if seeking a direction that the order protect another person. The order will automatically protect children of the applicant's family.

• *7 I have a domestic relationship with [full name of other person for whom protection from domestic violence is sought].

• *8 The nature of my domestic relationship with [full name] is as follows: [state sufficient facts to indicate the nature of the domestic relationship (ie, whether a spouse or partner, family or household member, a close personal relationship)]).

• *9 The respondent *is engaging/*has engaged in behaviour against [full name] that would amount to domestic violence against *him/*her if the respondent and *he/*she were in a domestic relationship, as follows: [state sufficient facts to indicate the nature and history of the respondent's behaviour towards the person].

• *10 The respondent's behaviour is due, in whole or in part, to my relationship with [full name]: [state sufficient facts to indicate the reasons for this belief].

• *11 It is necessary for the protection of [full name] that a direction be made that the protection order apply to *him/*her: [state sufficient facts to indicate the reasons for this belief].

• *12 [Full name] consents to the direction being made: [attach written consent if available, or indicate reasons for believing that the person consents].

or

• *12 It is not practicable for [full name] to consent to the direction being made, for the following reasons: [state why consent has not been obtained].

Complete paragraphs 13–15 if seeking direction that order apply to associated respondent

• *13 The respondent *is encouraging/*has encouraged [full name], the associated respondent, to engage in behaviour against (*me) (*a child of my family) (*the person referred to in paragraph 7) that would amount to domestic violence if engaged in by the respondent: [state sufficient facts to indicate the way in which the respondent is encouraging/has encouraged the associated respondent's behaviour].

• *14 The associated respondent has engaged in the behaviour set out in paragraph 13, as follows: [state sufficient facts to indicate the nature and history of the associated respondent's behaviour, including—

  • (a) an outline of the current situation or most recent incident:

  • (b) an outline of any behaviour that forms part of a pattern of behaviour from which protection is needed:

  • (c) details of any contact with Police, visits to a doctor or hospital].

• *15 The associated respondent—

  • *(a) holds a firearms licence:

  • *(b) possesses, or has under his/her control, weapons (as defined in the Domestic Violence Act 1995).

or

• *15 The associated respondent does not—

  • *(a) hold a firearms licence:

  • *(b) possess, or have under his/her control, weapons (as defined in the Domestic Violence Act 1995).

or

• *15 I do not know whether the associated respondent—

  • *(a) holds a firearms licence:

  • *(b) possesses, or has under his/her control, weapons (as defined in the Domestic Violence Act 1995).

Note: The Domestic Violence Act 1995 defines a weapon as any firearm, airgun, pistol, restricted weapon, ammunition, or explosive, as those terms are defined in the Arms Act 1983.

Complete paragraph 16 if applying for a protection order without notice to the respondent

• *16 The application for a protection order is being made without notice to the respondent (*and associated respondent) because the delay that would be caused by proceeding on notice would or might entail—

  • *(a) a risk of harm; or

  • *(b) undue hardship—

to (*me) (*a child of my family) (*both me and a child of my family), as follows: [state sufficient facts to indicate the reasons for these statements].

Complete paragraphs 17–19 (where applicable) if applying for occupation order

• *17 (*I (*own) (*have a legal interest in)) (*The respondent (*owns) (*has a legal interest in)) the dwellinghouse at [full address]. [State nature of legal interest if the property is not owned by either party].

• *18 The making of an occupation order is (*necessary for my protection) (*in the best interests of a child/children of my family) for the following reasons: [state reasons for belief. If seeking particular terms and conditions, indicate reasons for doing so].

• *19 The following people have an interest in the dwellinghouse that would be affected by the making of an occupation order: [list names of people, their addresses, and state the nature of their interests].

Complete paragraphs 20–22 (where applicable) if applying for tenancy order

• *20 The respondent is a (*sole tenant) (*a tenant holding jointly, or in common, with me) of the dwellinghouse at [full address].

• *21 The making of a tenancy order is (*necessary for my protection) (*in the best interests of a child/children of my family) for the following reasons: [state reasons for belief].

• *22 The following people have an interest in the dwellinghouse that would be affected by the making of a tenancy order: [list names of people, their addresses, and state the nature of their interests].

Complete paragraphs 23–25 (where applicable) if applying for ancillary furniture order

• *23 I (*am applying for (*an occupation order) (*a tenancy order)) (*have a current (*occupation order) (*tenancy order)) in respect of the dwellinghouse situated at [full address].

• *24 The respondent and I have lived in the same dwellinghouse at the same time for [state period that you and the respondent lived in same house at same time] and (*I am) (*I will be) living in the dwellinghouse specified in paragraph 23. [If not currently living in the dwellinghouse, give sufficient information to indicate intention to return. If seeking particular terms or conditions, indicate the reasons for doing so].

• *25 The following people have an interest in the furniture, household appliances, and household effects that would be affected by the making of an ancillary furniture order: [list names of people, their addresses, and state the nature of their interests].

Complete paragraphs 26–31 (where applicable) if applying for furniture order

• *26 I (*am applying for) (*have been granted) a protection order against the respondent.

• *27 The respondent and I (*live in the same dwellinghouse at [full address]) (*have lived in the same dwellinghouse at [full address] at the same time).

• *28 I (*am not applying for) (*did not apply for) an occupation order or a tenancy order in respect of that dwellinghouse.

• *29 A child/children of my family (*is/are living) (*has/have lived) in that dwellinghouse.

• *30 The furniture, household appliances, and household effects in respect of which I am seeking a furniture order are reasonably required to equip another dwellinghouse in which (*I am living/will live) (*a child of my family lives/will live) (*both I and a child of my family are living/will live): [state sufficient facts to indicate the reasons for these statements. If seeking particular terms or conditions, indicate the reasons for doing so].

• *31 The following people have an interest in the furniture, household appliances, and household effects that would be affected by the making of a furniture order: [list names of people, their addresses, and state the nature of their interests].

Complete paragraph 32 if applying for a property order without notice to the respondent

• *32 The application for (*an occupation order) (*a tenancy order) (*an ancillary furniture order) (*a furniture order) is made without notice to the respondent because—

  • *(a) the respondent has (*physically abused) (*sexually abused) (*me) (*a child of my family); and

  • *(b) the delay that would be caused by proceeding on notice would or might expose (*me) (*a child of my family) to physical or sexual abuse.

[State sufficient facts to indicate the reasons for these statements].

[Set out sufficient information to inform the court of any other facts relied on in support of each application].

• 1 Rule 9(2) of the Domestic Violence Rules 1996 permits this form to be varied where the circumstances of a particular case require.

• 2 Material referred to in this affidavit may be attached as an exhibit, endorsed with the appropriate exhibit note.

• 3 It is not necessary to repeat the full name of a person referred to more than once in the affidavit so long as the identity of the person being referred to in a particular paragraph is clear.

• 4 If the facts that support particular applications have been referred to in earlier paragraphs, it is sufficient to refer back to those paragraphs by number rather than repeating the facts.

• 5 A separate affidavit by the person referred to in paragraph 7 and giving details of the respondent's behaviour may be necessary.

• 6 Rules 22 and 45 of the Domestic Violence Rules 1996 permit the applicant to omit his/her residential address from this affidavit if he/she wants the address to be kept confidential from the respondent or the associated respondent.

• Schedule 1 form DV 3: amended, on 26 April 2005, by section 12 of the Relationships (Statutory References) Act 2005 (2005 No 3).

Domestic Violence Act 1995

To the Registrar

District Court

[Place]

I, [full name], am applying for a protection order against [full name], the respondent.

My residential address is [address].

My contact telephone number(s) is/are: [home, work]

I request that my residential address and telephone numbers be kept confidential from the respondent (*and the associated respondent).

I have provided an address for service on the information sheet accompanying the application.

Domestic Violence Act 1995

Full name:

*Residential address:

*Contact telephone number(s): [home, work]

*These details must not be disclosed to the respondent or associated respondent.

Full name:

Residential address:

Occupation:

Name and address of employer:

*Contact telephone number(s): [home, work]

Date of birth:

Age in years:

Full name:

Residential address:

Occupation:

Name and address of employer:

*Contact telephone number(s): [home, work]

Date of birth:

Age in years:

Circle the appropriate answer. Please see the note at the end of this form about what is a weapon.

Meaning of weapon

The Domestic Violence Act 1995 defines a weapon as any firearm, airgun, pistol, restricted weapon, ammunition, or explosive, as those terms are defined in the Arms Act 1983.

Section 9 (or section 11 or section 12), Domestic Violence Act 1995

I, [full name], apply (*without notice) for an order appointing me as representative of [full name of minor to be represented], the minor, on the following grounds:

• (a) the minor is eligible to apply for a protection order:

• (b) I am an adult, I am not under disability, and there is unlikely to be any conflict between my interests and the interests of the minor.

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the age of the minor and your relationship to the minor); or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the age of the minor and your relationship to minor)].

I, [full name], apply (*without notice) for an order appointing me as representative of [full name of person to be represented], the specified person, on the following grounds:

• (a) the specified person is eligible to apply for a (*protection order) (*property order):

• *(b) the specified person lacks, wholly or partly, the capacity to understand the nature, and to foresee the consequences, of decisions in respect of matters relating to (*his) (*her) personal care and welfare:

or

• *(b) the specified person has the capacity to understand the nature, and to foresee the consequences, of decisions in respect of matters relating to (*his) (*her) personal care and welfare, but wholly lacks the capacity to communicate decisions in respect of such matters:

• (c) an application for a (*protection order) (*property order) must be made, on the specified person's behalf, by a representative because—

  • *(i) no one has power, under an appointment made under the Protection of Personal and Property Rights Act 1988, to make the application on the specified person's behalf; or

  • *(ii) although a person has power, under an appointment made under the Protection of Personal and Property Rights Act 1988, to make the application on the specified person's behalf, that person has refused or failed to do so; or

  • *(iii) the specified person is a minor who is under the age of 16 years:

• (d) I am an adult, I am not under disability, and there is unlikely to be any conflict between my interests and the interests of the specified person.

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the reasons for believing that the specified person lacks capacity); or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the reasons for believing that the specified person lacks capacity)].

I, [full name], apply without notice for an order appointing me as representative of [full name of person to be represented], the specified person, on the following grounds:

• (a) the specified person is eligible to apply for a (*protection order) (*property order):

• (b) the specified person is unable to make the application personally:

• (c) it is desirable that (*the protection order) (*the property order) be sought on an application without notice:

• (d) reasonable steps have been taken to ascertain the wishes of the specified person in relation to this application, (*and those wishes have been ascertained) (*but those wishes have not been able to be ascertained):

• *(e) the specified person—

  • *(i) does not object to my appointment; or

  • *(ii) objects to my appointment, but that objection is not freely made:

• (f) it is in the best interests of the specified person to make this appointment:

• (g) I am an adult, I am not under disability, and there is unlikely to be any conflict between my interests and the interests of the specified person.

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the reasons for believing that the specified person is unable to make the application personally); or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application (including the reasons for believing that the specified person is unable to make the application personally)].

This application is filed by ......., whose address for service is at [address].

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing of this application.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 6: amended, on 26 April 2005, by section 12 of the Relationships (Statutory References) Act 2005 (2005 No 3).

Domestic Violence Act 1995

I, [full name], apply for an order [state precisely the nature of the order sought] on the following grounds:

[State the grounds on which the application is made, referring to the section of the Act or the rule relied on, and following closely the wording of the section or rule].

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application; or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application].

The parties to this application were (*the parties) (*some of the parties) to a previous application—

• *(a) under the Domestic Violence Act 1995; or

• *(b) under [specify previous enactment corresponding to Domestic Violence Act 1995]; or

• *(c) to which the Family Proceedings Rules 1981 apply,—

and that previous application was filed in a court other than the court in which this application is filed.

*The file number of that previous application is [specify].

or

*[State other information that may assist in identifying the file].

*The previous application was filed in the [name of court] Court at [place].

*I request that all documents relating to the previous application be transferred to the court in which this application is filed.

District Court

[Place]

and

To the respondent

This application is filed by ......., whose address for service is at [address].

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing of this application.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

Domestic Violence Act 1995

I, [full name], apply without notice for an order [state precisely the nature of the order sought] on the following grounds:

[State the grounds on which the application is made, referring to the section of the Act or the rule relied on, and following closely the wording of the section or rule].

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application; or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application].

The parties to this application were (*the parties) (*some of the parties) to a previous application—

• *(a) under the Domestic Violence Act 1995; or

• *(b) under [specify previous enactment corresponding to Domestic Violence Act 1995]; or

• *(c) to which the Family Proceedings Rules 1981 apply,—

and that previous application was filed in a court other than the court in which this application is filed.

*The file number of that previous application is [specify].

or

*[State other information that may assist in identifying the file].

*The previous application was filed in the [name of court] Court at [place].

*I request that all documents relating to the previous application be transferred to the court in which this application is filed.

District Court

[Place]

This application is filed by ......., whose address for service is at [address].

The Registrar is to complete the following appointment for hearing if an appearance is necessary or required.

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing of this application.

Section 22, Domestic Violence Act 1995

I, [full name], apply (*without notice) for a variation of the (*temporary) protection order made on [date] in favour of [full name of applicant for protection order] against [full name of respondent].

I apply for the court to vary the order (*, in so far as it relates to the associated respondent,) by—

• *(a) directing that the standard condition relating to weapons is to be a condition of the order (*without modification) (*with the following modifications: [specify modifications sought]); or

• *(b) discharging the standard condition relating to weapons; or

• *(c) modifying the terms of the standard condition relating to weapons as follows: [specify modifications sought].

You must—

• (a) file an affidavit containing sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application; or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say: [set out sufficient particulars to show the grounds on which you claim to be entitled to the order sought, and sufficient information to inform the court of the facts relied on in support of the application].

District Court

[Place]

and

To (*the protected person(s))

(*The respondent) (*the associated respondent)

This application is filed by ......., whose address for service is at [address].

The Registrar is to complete the following appointment for hearing if an appearance is necessary or required.

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing of this application.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

Domestic Violence Act 1995

No:

In the District Court at:

[Full name], the applicant, has filed an application in this court.

A copy of the application is attached. The order or orders sought are specified in the application.

The applicant's address for service is [address].

If you wish to defend the application, you may file a notice of defence in this office of the court at least 5 clear days before the date of the hearing. In some cases, an affidavit must be filed with the notice of defence.

If you file a notice of defence, you must serve a copy of the notice of defence on the other party to the proceedings. That copy may be delivered to the address for service given by the applicant.

You should note that if you do not file and serve a notice of defence and an affidavit (if required) at least 5 clear days before the date of the hearing you may not be able to defend the application. On the day of the hearing of the application, should you appear, the Judge may—

• (a) allow you to take part in the hearing of the application only on such terms as the Judge thinks fit; or

• (b) decline to allow you to take part.

You should also note that the Judge may make an order against you for costs properly incurred as a consequence of your failure to file and serve a notice of defence and an affidavit (if required) within time.

If you do not wish to defend the application but you do wish to know what is happening, you should—

• (a) file in this office of the court a notice giving the address of a place in New Zealand at which documents can be left for you; and

• (b) serve a copy of the notice on the other party to the proceedings. That copy may be delivered to the address for service given by the applicant.

If you wish, a lawyer will prepare a notice of defence for you. If you want a lawyer but think you cannot afford one, you should contact an office of the District Court immediately. You may also see an example of the form of the notice of defence at any office of the District Court.

You will get copies of any orders made against you. However, any order will probably be in force from the time it is made. The fact that you have not got a copy of the order will not be an excuse for not obeying it.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 10: amended, on 3 August 2009, by rule 6 of the Domestic Violence Amendment Rules 2009 (SR 2009/189).

Domestic Violence Act 1995

I, [full name], of [address], [occupation], the (*respondent) (*associated respondent), give notice that I intend to defend the application for [specify the order(s)].

If this notice is filed in respect of an application for a protection order or a property order, you must file with the notice an affidavit setting out sufficient particulars to indicate the grounds on which the defence is based, and sufficient information to inform the court of the facts relied on in support of the defence. The affidavit should cover the matters set out below in relation to a statement in support.

If this notice relates to another kind of application, you must—

• (a) file an affidavit setting out sufficient particulars to indicate the grounds on which the defence is based, and sufficient information to inform the court of the facts relied on in support of the defence. The affidavit should cover the matters set out below in relation to a statement in support; or

• (b) complete a statement in support as set out below.

I rely on the content of the affidavit dated [specify date] filed in support of this application.

or

I say, in answer to the applicant:

• 1 [State whether the facts given in the application are accepted or rejected. If any facts are rejected, state reasons].

• 2 [Set out sufficient particulars to indicate the grounds on which the defence is based, and sufficient information to inform the court of the facts relied on in support of the defence].

• 3 [Set out any other facts relating to the application or to the circumstances that have existed or are existing between the parties that the court should be told about].

District Court

[Place]

and

To the applicant

(*The respondent) (*the associated respondent)

This notice is filed by ......., whose address for service is at [address].

Section 76, Domestic Violence Act 1995

I, [full name], of [address], [occupation], the (*respondent) (*associated respondent), give notice that I wish to be heard on whether a final order should be substituted for the following temporary order/s made on [date]:

*Protection order:

*Occupation order:

*Tenancy order:

*Ancillary furniture order:

*Furniture order.

You must file an affidavit with this notice. The affidavit should—

• (a) set out sufficient particulars to indicate the reasons for giving notice; and

• (b) state whether the facts given in the affidavit in support of the application are accepted or rejected. If any facts are rejected, state reasons; and

• (c) set out any other facts relating to the application or to the circumstances that have existed or are existing between the parties that the court should be told about.

I rely on the content of the affidavit dated [specify date] filed in support of this notice.

District Court

[Place]

and

To the applicant

(*The respondent) (*the associated respondent)

This notice is filed by ......., whose address for service is at [address].

I appoint [date] at ... am (pm) at the District Court at [place] for the hearing.

Domestic Violence Act 1995

In the District Court

at [place]

To [full name of respondent or associated respondent], [occupation], formerly of [address].

[Full name of applicant] has filed an application against you for the following orders: [state orders applied for].

A copy of the application, with a notice containing information for you, may be obtained from my office.

The application has been set down for hearing on [date].

Domestic Violence Act 1995

I [full name], of [address], [occupation], *swear *affirm:

• 1 On [date] I served on [full name], (*the respondent) (*the associated respondent), a copy of [specify document] annexed to this affidavit and marked with the letter “A” by delivering it to *him/*her personally at [address].

or

• 1 On [date] at [time—see rule 60(3)] I served on [full name], (*the respondent) (*the associated respondent), a copy of the (*temporary protection order) (*final protection order) annexed to this affidavit and marked with the letter “A” by delivering it to (*the respondent) (*the associated respondent) personally at [address].

• 2 At the same time I served on (*the respondent) (*associated respondent) a copy of [specify document] annexed to this affidavit and marked with the letter “B” by delivering it to *him/*her personally at [address].

• 3 (*The respondent) (*the associated respondent) is personally known to me by reason of the following facts: [state the facts establishing personal knowledge].

or

• 3 (*The respondent) (*the associated respondent) is not personally known to me, but I believe that the person served by me is (*the respondent) (*the associated respondent) by reason of the following facts: [state the facts on which the deponent relies].

Section 82, Domestic Violence Act 1995

To: [full name], of [address], [occupation].

*Summons to appear as witness

(*An application has been made by [full name], the applicant, against [full name], the respondent, for the following order(s): [specify nature of order(s) sought].)

(*On application by [full name], the applicant, against [full name], the respondent, the court has made the following temporary order: [specify order made].)

(*A hearing is to be held to decide—

• *(a) whether the order(s) sought should be made; or

• *(b) whether a final order should be substituted for the temporary order; or

• *(c) whether specified parts of the order made or sought should be part of a final order.)

I believe that you are capable of giving evidence that may assist the court.

*Summons to appear before court

*On [date] the court directed you to attend a programme.

The programme provider of that programme—

• *(a) has notified the Registrar that you have failed to comply with that direction as follows: [set out nature of non-compliance alleged]; or

• *(b) has requested that the direction be varied because the programme provider considers that—

  • *(i) the programme is not appropriate for you; or

  • *(ii) you are not participating fully in the programme, and this is significantly affecting your ability to benefit fully from the programme.

You are summoned to appear (*as a witness) at the hearing at ...am (pm) on [date] at the District Court at [place].

If (*, having been tendered or paid allowances and travelling expenses at the appropriate rate,) you fail to attend, the court may issue a warrant to arrest you and bring you before the court.

If, without sufficient cause, you refuse or fail to attend, you may be prosecuted and fined.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

Section 14, Domestic Violence Act 1995

Upon application without notice the court makes a temporary protection order against [full name], the respondent.

*Order to apply against other person(s) (associated respondent(s))

*The court also directs that the order applies against the following person(s):

[Full name of each person in respect of whom the court makes a direction under section 17(1) of the Act].

Person(s) protected by the order (protected person(s))

This order protects the following person(s):

[Full name of applicant]:

*[Full name of each child of the applicant's family]:

*The court also directs that the order applies for the benefit of the following person(s):

[Full name of each person in respect of whom the court makes a direction under section 16(2) of the Act].

• (a) Standard conditions prohibiting domestic violence and contact

It is a condition of this order that—

• 1 The respondent, and any associated respondent, must not—

  • (a) physically or sexually abuse any protected person; or

  • (b) threaten to physically or sexually abuse any protected person; or

  • (c) damage, or threaten to damage, property of any protected person; or

  • (d) engage, or threaten to engage, in other behaviour, including intimidation or harassment, which amounts to psychological abuse of any protected person; or

  • (e) encourage any person to engage in behaviour against any protected person, where the behaviour, if engaged in by the respondent or any associated respondent, would be prohibited by the order:

• 2 Unless the protected person and the respondent or associated respondent are living in the same dwellinghouse with the express consent** of the protected person (which may be withdrawn at any time), the respondent or associated respondent must not—

  • (a) watch, loiter near, or prevent or hinder access to or from, any protected person's place of residence, business, employment, educational institution, or any other place that any protected person visits often; or

  • (b) follow any protected person about or stop or accost any protected person in any place; or

  • (c) without the protected person's express consent**, enter or remain on any land or building occupied by any protected person; or

  • (d) where any protected person is present on any land or building, enter or remain on that land or building in circumstances that constitute a trespass; or

  • (e) make any other contact with any protected person (whether by telephone, electronic message, correspondence, or otherwise), except such contact—

    • (i) as is reasonably necessary in any emergency; or

    • (ii) as is permitted under any order or written agreement relating to custody of, or access to, any minor; or

    • (iii) as is permitted under any special condition of this protection order; or

    • (iv) as is necessary for the purposes of attending a family group conference under the Children, Young Persons, and Their Families Act 1989.

**The court may specify, in a special condition of a protection order, a person who may consent or withdraw consent on a protected person's behalf

• (b) Standard conditions relating to weapons

It is also a condition of this order that the respondent, and any associated respondent,—

• (a) must not possess, or have under his or her control, any weapon; and

• (b) must not hold a firearms licence; and

• (c) must,—

  • (i) as soon as practicable after being served with a copy of this order, but in any case no later than 24 hours after such service; and

  • (ii) on demand made, at any time, by any member of the Police,—

  • surrender to a member of the Police—

  • (iii) any weapon in his or her possession, or under his or her control, whether or not the weapon is lawfully in his or her possession or under his or her control; and

  • (iv) any firearms licence held by him or her.

Note: Weapon means any firearm, airgun, pistol, restricted weapon, ammunition, or explosive, as those terms are defined in the Arms Act 1983.

• *(c) Special conditions

The court also imposes the following special conditions: [set out any special conditions imposed].

Unless otherwise stated, these conditions last for the duration of this order.

• *(d) Attendance at programme

The court directs [full name of respondent and/or associated respondent] to attend the following programme: [specify name of programme and programme provider].

The (*respondent) (*associated respondent) must attend the programme—

• *(a) for [number] of sessions per month; or

• *(b) for 1 session per month and for such other session or sessions per month as the programme provider from time to time specifies; or

• *(c) for such number of sessions per month as the programme provider from time to time specifies.

The (*respondent) (*associated respondent) must attend the programme for the first time—

• *(a) on [date] at ... am/pm at [place]; or

• *(b) on a date and at a time and place to be advised by the programme provider as soon as practicable.

The court directs that there be a hearing in relation to (*the whole of this order) (*the following parts of this order: [specify parts]).

I appoint [date] at ... am (pm) at the District Court at [place] for this hearing.

The applicant has made an application to the court for a protection order, and this order has been made without notice first being given to you. A copy of the application and related papers—

• *(a) accompany this order; or

• *(b) will be served on you shortly; or

• *(c) may be obtained from (*the court that made the order) (*[specify place]).

This order is a temporary order.

(*If you do nothing after being served, this order will automatically become a final order 3 months after the date on which it was made. The final order will come into effect immediately. If you wish to dispute this temporary protection order, you must notify the court as soon as possible.)

(*The court has directed that a hearing be held in relation to (*the whole of this order) (*specified parts of this order).

This hearing will take place whether or not you wish to appear. If you wish to dispute any part of the order, you must notify the court as soon as possible.

If you do nothing, (*the court may make a final order in your absence) (*the parts of the order in relation to which a hearing is not required will become final 3 months after the date on which this order was made, and the court may confirm the other parts of the order at the hearing.))

The effect of this condition is that any firearms licence held by you is automatically suspended as soon as this order is made. If the order becomes final, the licence is automatically revoked. However, you can apply to the court to modify or discharge this condition (see below).

If you do not surrender to the Police all weapons in your possession or under your control, and your firearms licence, within 24 hours after being served with this order, or on demand made by a member of the Police, the Police can use their powers under the Arms Act 1983 to enter your property without warrant and search for and seize the weapons. You may also be prosecuted for failing to comply with this order (see below).

The court has directed you to attend a programme. You have 10 working days after you have been served with this order to notify the court if you object to that direction.

If you do not make an objection within the 10 working day period, and then fail to attend programme sessions, you may be prosecuted for failing to comply with this order (see below).

The effect of this order is to prohibit you from having contact with any protected person in any of the ways set out in the order. This order may also contain special conditions relating to contact between you and a protected person. You should read the terms of the order very carefully to find out what contact you may or may not have with any protected person.

If the protected person has expressly consented to living in the same dwellinghouse with you, the prohibition on contact, and any special condition that is inconsistent with living in the same dwellinghouse, are suspended.

The protected person may withdraw that consent at any time. If that happens (and this order has not in the meantime been discharged or varied), you must comply with all the standard conditions and special conditions of the order.

Note that the special conditions of this order may specify who is entitled to consent (or withdraw consent) on behalf of a protected person.

If a child of the applicant's family attains the age of 17 and continues to ordinarily or periodically reside with the applicant, then that adult child continues to be a protected person under this order.

If the applicant dies, this order continues to apply for the benefit of the other protected persons until it lapses or is discharged. In the case of a protected person who at the time of the applicant's death was a child of the applicant's family, the order continues to apply to that person until he or she attains the age of 17, unless it sooner lapses or is discharged.

You (or any other party) can apply to the court at any time—

• (a) for the modification or discharge of the standard condition relating to weapons. (The court may make a change to this standard condition only if it is satisfied that the condition, or a term of the condition, is not needed to protect the persons for whose benefit this order applies from further domestic violence):

• (b) for a variation or discharge of any special conditions of this order, or for the imposition of a new special condition:

• (c) for the variation or discharge of a direction to attend a programme, or for such a direction to be made:

• (d) for this order to be discharged.

You commit an offence if you breach the order by—

• (a) doing an act in contravention of this order; or

• (b) failing to comply with any condition in this order.

You have a defence to proceedings for this offence if you can prove that you had a reasonable excuse for breaching the order.

The maximum penalty for this offence is 2 years' imprisonment.

If a constable has good cause to suspect that you have breached this order, you may be arrested without warrant. Police bail is not available during the 24 hours immediately following an arrest. During that period, any bail application must be made to a Judge.

You commit an offence if, without reasonable excuse, you fail on any occasion to comply with a direction to attend a programme.

The maximum penalty for this offence is 6 months' imprisonment or a fine not exceeding $5,000.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order has been made without notice first being given to the respondent.

This order is a temporary order.

(*If the respondent or associated respondent does nothing after being served, this order will automatically become a final order 3 months after the date on which it was made and will come into effect immediately. You will then be sent a copy of the final order. The respondent or associated respondent may, however, give notice that he or she wishes to dispute this order. In that case, a hearing will be held and you will be notified of the hearing date.)

(*The court has directed that a hearing be held in relation to (*the whole of this order) (*specified parts of this order).

You are entitled to appear or be represented at the hearing to present your case to satisfy the court that (*the order should be made final) (*the parts of the order in relation to which the hearing is required should be part of the final order. If the respondent does nothing, the parts of the order in relation to which a hearing is not required will become final 3 months after the date on which this order was made, and the court may confirm the other parts of the order at the hearing.))

The effect of this order is to prohibit the respondent or associated respondent from having contact with you in any of the ways set out in the order. This order may also contain special conditions relating to contact between you and the respondent or associated respondent.

If you expressly consent to living in the same dwellinghouse with the respondent or associated respondent, the prohibition on contact, and any special condition that is inconsistent with living in the same dwellinghouse, are suspended.

You may withdraw that consent at any time. If that happens (and this order has not in the meantime been discharged or varied), the respondent or associated respondent must comply with all the standard conditions and special conditions of the order.

Note that the special conditions of this order may specify who is entitled to consent (or withdraw consent) on behalf of a protected person.

The effect of this condition is that any firearms licence held by the respondent or associated respondent is automatically suspended as soon as this order is made. If the order becomes final, the licence is automatically revoked. However, this condition may be modified or discharged by the court (see below).

If you have requested referral to a programme, you will be advised in the near future of the programme provider and the relevant dates. If you wish to make such a request for yourself or for any child or other person protected by the order, you may do so by contacting the Registrar.

You (or any other party, including the respondent or associated respondent) can apply to the court at any time—

• (a) for the modification or discharge of the standard condition relating to weapons. (The court may make a change to this standard condition only if it is satisfied that the condition, or a term of the condition, is not needed to protect the persons for whose benefit this order applies from further domestic violence):

• (b) for a variation or discharge of any special conditions of this order, or for the imposition of a new special condition:

• (c) for the variation or discharge of a direction that the respondent or associated respondent attend a programme, or for such a direction to be made:

• (d) for this order to be discharged.

If the respondent or associated respondent makes any of these applications, you will be notified and have an opportunity to dispute the application.

The respondent or associated respondent commits an offence if he or she—

• (a) does any act in contravention of this order; or

• (b) fails to comply with any condition in this order.

The respondent or associated respondent will have a defence to proceedings for this offence if it can be proved that he or she had a reasonable excuse for breaching the order.

The maximum penalty for this offence is 2 years' imprisonment.

If a constable has good cause to suspect that the respondent or associated respondent has breached the order, the respondent or associated respondent may be arrested without warrant. Police bail is not available during the 24 hours immediately following an arrest. During that period, any bail application must be made to a Judge.

The respondent or associated respondent commits an offence if, without reasonable excuse, he or she fails on any occasion to comply with a direction to attend a programme.

The maximum penalty for this offence is 6 months' imprisonment or a fine not exceeding $5,000.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 16: amended, on 17 November 2011, by rule 5(1) of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 16: amended, on 17 November 2011, by rule 5(2) of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 16: amended, on 17 November 2011, by rule 5(3) of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 16: amended, on 17 November 2011, by rule 5(4) of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 16: amended, on 17 November 2011, by rule 5(5) of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 16: amended, on 28 October 2009, by section 10 of the Domestic Violence Amendment Act 2009 (2009 No 43).

Section 14, Domestic Violence Act 1995

*Upon application the court makes a protection order against [full name], the respondent.

*Upon application without notice the court made a temporary protection order against [full name], the respondent on [date], which order is now final (*in whole) (*in part) (*with modifications) (*without modification).

*The court also directs that the order applies against the following person(s):

[Full name of each person in respect of whom the court makes a direction under section 17(1) of the Act].

This order protects the following person(s):

[Full name of applicant]:

*[Full name of each child of the applicant's family]:

*The court also directs that the order applies for the benefit of the following person(s):

[Full name of each person in respect of whom the court makes a direction under section 16(2) of the Act].

• (a) Standard conditions prohibiting domestic violence and contact

It is a condition of this order that—

• 1 The respondent, and any associated respondent, must not—

  • (a) physically or sexually abuse any protected person; or

  • (b) threaten to physically or sexually abuse any protected person; or

  • (c) damage, or threaten to damage, property of any protected person; or

  • (d) engage, or threaten to engage, in other behaviour, including intimidation or harassment, which amounts to psychological abuse of any protected person; or

  • (e) encourage any person to engage in behaviour against any protected person, where the behaviour, if engaged in by the respondent or any associated respondent, would be prohibited by the order:

• 2 Unless the protected person and the respondent or associated respondent are living in the same dwellinghouse with the express consent** of the protected person (which may be withdrawn at any time), the respondent or associated respondent must not—

  • (a) watch, loiter near, or prevent or hinder access to or from, any protected person's place of residence, business, employment, educational institution, or any other place that any protected person visits often; or

  • (b) follow any protected person about or stop or accost any protected person in any place; or

  • (c) without the protected person's express consent**, enter or remain on any land or building occupied by any protected person; or

  • (d) where any protected person is present on any land or building, enter or remain on that land or building in circumstances that constitute a trespass; or

  • (e) make any other contact with any protected person (whether by telephone, electronic message, correspondence, or otherwise), except such contact—

    • (i) as is reasonably necessary in any emergency; or

    • (ii) as is permitted under any order or written agreement relating to custody of, or access to, any minor; or

    • (iii) as is permitted under any special condition of this protection order; or

    • (iv) as is necessary for the purposes of attending a family group conference under the Children, Young Persons, and Their Families Act 1989.

**The court may specify, in a special condition of a protection order, a person who may consent or withdraw consent on a protected person's behalf

• *(b) Standard conditions relating to weapons

It is also a condition of this order that the respondent, and any associated respondent,—

• (a) must not possess, or have under his or her control, any weapon; and

• (b) must not hold a firearms licence; and

• (c) must,—

  • (i) as soon as practicable after being served with a copy of this order, but in any case no later than 24 hours after such service; and

  • (ii) on demand made, at any time, by any member of the Police,—

• surrender to a member of the Police—

  • (iii) any weapon in his or her possession, or under his or her control, whether or not the weapon is lawfully in his or her possession or under his or her control; and

  • (iv) any firearms licence held by him or her.

Note: Weapon means any firearm, airgun, pistol, restricted weapon, ammunition or explosive, as those terms are defined in the Arms Act 1983.

Where the court has modified the terms of the standard condition relating to weapons, or directed that the standard condition relating to weapons not be a condition of the order (whether absolutely or only in so far as the order relates to the respondent or associated respondent), set out the terms of the court's decision.

• *(c) Special conditions

The court also imposes the following special conditions: [set out any special conditions imposed].

Unless otherwise stated, these conditions last for the duration of this order.

• *(d) Attendance at programme

The court (*directs) (*has directed) [full name of respondent and/or associated respondent] to attend the following programme: [specify name of programme and programme provider].

The (*respondent) (*associated respondent) must attend the programme—

• *(a) for [number] of sessions per month; or

• *(b) for 1 session per month and for such other session or sessions per month as the programme provider from time to time specifies; or

• *(c) for such number of sessions per month as the programme provider from time to time specifies).

The (*respondent) (*associated respondent) must attend the programme for the first time—

• *(a) on [date] at ... am/pm at [place]; or

• *(b) on a date and at a time and place to be advised by the programme provider as soon as practicable.

This order is a final protection order that lasts indefinitely. Certain conditions of this order may have a limited duration.

*The effect of this condition is that any firearms licence held by you is automatically revoked.

*If you have not already done so, you must surrender to the Police all weapons in your possession or under your control, and your firearms licence, within 24 hours after being served with this order or on demand made by a member of the Police. If you do not, the Police can use their powers under the Arms Act 1983 to enter your property without warrant and search for and seize the weapons. You may also be prosecuted for failing to comply with this order (see below).

*This order may permit you to have in your possession, or under your control, a specified weapon, or weapons of a specified class, either unconditionally or subject to certain conditions. You may also be permitted to hold a firearms licence. You are in breach of this order if you possess weapons, or have weapons under your control, other than as permitted by this order.

The court has directed you to attend a programme. If you fail to attend programme sessions, you may be prosecuted for failing to comply with this order (see below).

The effect of this order is to prohibit you from having contact with any protected person in any of the ways set out in the order. This order may also contain special conditions relating to contact between you and a protected person. You should read the terms of the order very carefully to find out what contact you may or may not have with any protected person. If the protected person has expressly consented to living in the same dwellinghouse with you, the prohibition on contact, and any special condition that is inconsistent with living in the same dwellinghouse, are suspended.

The protected person may withdraw that consent at any time. If that happens (and this order has not in the meantime been discharged or varied), you must comply with all the standard conditions and special conditions of the order.

Note that the special conditions of this order may specify who is entitled to consent (or withdraw consent) on behalf of a protected person.

If a child of the applicant's family attains the age of 17 and continues to ordinarily or periodically reside with the applicant, then that adult child continues to be a protected person under this order.

If the applicant dies, this order continues to apply for the benefit of the other protected persons until it lapses or is discharged. In the case of a protected person who at the time of the applicant's death was a child of the applicant's family, the order continues to apply to that person until he or she attains the age of 17, unless it sooner lapses or is discharged.

You (or any other party) can apply to the court at any time—

• (a) for the modification or discharge of the standard condition relating to weapons. (The court may make a change to this standard condition only if it is satisfied that the condition, or a term of the condition, is not needed to protect the persons for whose benefit this order applies from further domestic violence):

• (b) for a variation or discharge of any special conditions of this order, or for the imposition of a new special condition:

• (c) for the variation or discharge of a direction to attend a programme, or for such a direction to be made:

• (d) for this order to be discharged.

You commit an offence if you breach the order by—

• (a) doing an act in contravention of this order; or

• (b) failing to comply with any condition in this order.

You have a defence to proceedings for this offence if you can prove that you had a reasonable excuse for breaching the order.

The maximum penalty for this offence is 2 years' imprisonment.

If a constable has good cause to suspect that you have breached this order, you may be arrested without warrant. Police bail is not available during the 24 hours immediately following an arrest. During that period, any bail application must be made to a Judge.

You commit an offence if, without reasonable excuse, you fail on any occasion to comply with a direction to attend a programme.

The maximum penalty for this offence is 6 months' imprisonment or a fine not exceeding $5,000.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order is a final protection order that lasts indefinitely. Certain conditions of this order may have a limited duration.

The effect of this order is to prohibit the respondent or associated respondent from having contact with you in any of the ways set out in the order. This order may also contain special conditions relating to contact between you and the respondent or associated respondent.

If you expressly consent to living in the same dwellinghouse with the respondent or associated respondent, the prohibition on contact, and any special condition that is inconsistent with living in the same dwellinghouse, are suspended.

You may withdraw that consent at any time. If that happens (and this order has not in the meantime been discharged or varied), the respondent or associated respondent must comply with all the standard conditions and special conditions of the order.

Note that the special conditions of this order may specify who is entitled to consent (or withdraw consent) on behalf of a protected person.

If you have requested referral to a programme, you will be advised in the near future of the programme provider and the relevant dates. If you wish to make such a request for yourself or for any child or other person protected by the order, you may do so by contacting the Registrar.

You (or any other party, including the respondent or associated respondent) can apply to the court at any time—

• (a) for the modification or discharge of the standard condition relating to weapons. (The court may make a change to this standard condition only if it is satisfied that the condition, or a term of the condition, is not needed to protect the persons for whose benefit this order applies from further domestic violence):

• (b) for a variation or discharge of any special conditions of this order, or for the imposition of a new special condition:

• (c) for the variation or discharge of a direction that the respondent or associated respondent attend a programme, or for such a direction to be made:

• (d) for this order to be discharged.

If the respondent or associated respondent makes any of these applications, you will be notified and have an opportunity to dispute the application.

The respondent or associated respondent commits an offence if he or she—

• (a) does any act in contravention of this order; or

• (b) fails to comply with any condition in this order.

The respondent or associated respondent will have a defence to proceedings for this offence if it can be proved that he or she had a reasonable excuse for breaching the order.

The maximum penalty for this offence is 2 years' imprisonment.

If a constable has good cause to suspect that the respondent or associated respondent has breached the order, the respondent or associated respondent may be arrested without warrant. Police bail is not available during the 24 hours immediately following an arrest. During that period, any bail application must be made to a Judge.

The respondent or associated respondent commits an offence if, without reasonable excuse, he or she fails on any occasion to comply with a direction to attend a programme.

The maximum penalty for this offence is 6 months' imprisonment or a fine not exceeding $5,000.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 17: amended, on 17 November 2011, by rule 6 of the Domestic Violence Amendment Rules 2011 (SR 2011/348).

• Schedule 1 form DV 17: amended, on 28 October 2009, by section 10 of the Domestic Violence Amendment Act 2009 (2009 No 43).

Section 53, Domestic Violence Act 1995

Upon application without notice the court makes a temporary occupation order against [full name], the respondent.

The court orders that [full name], the applicant, is entitled, to the exclusion of the respondent, to personally occupy the dwellinghouse at [full address], together with any land, buildings, or improvements appurtenant to the dwellinghouse which are used, or ordinarily would be used, for the purposes of a household.

*The court directs that the applicant is entitled to occupy the dwellinghouse for the period from ....... to .......

*The court also imposes the following terms and conditions relating to the occupation of the dwellinghouse: [set out any terms and conditions imposed].

The court directs that there be a hearing in relation to (*the whole of this order) (*the following parts of this order: [specify parts]).

I appoint [date] at ... am (pm) at the District Court at [place] for this hearing.

The applicant has made an application to the court, and this order has been made without notice first being given to you. A copy of the application and related papers—

• *(a) accompany this order; or

• *(b) will be served on you shortly; or

• *(c) may be obtained from (*the court that made the order) (*[specify place]).

This order is a temporary order.

(*If you do nothing after being served, this order will (subject to notice being given to other persons with an interest in the property) automatically become a final order 3 months after the date on which it was made. If you wish to dispute this order, you must notify the court as soon as possible.)

(*The court has directed that a hearing be held in relation to (*the whole of this order) (*specified parts of this order).

This hearing will take place whether or not you wish to appear. If you wish to dispute any part of the order, you must notify the court as soon as possible.

If you do nothing (*the court may make a final order in your absence) (*the parts of the order in relation to which a hearing is not required will become final 3 months after the date on which this order was made, and the court may confirm the other parts of the order at the hearing.))

(*If another person who has an interest in the property and who has been given notice wishes to be heard, a hearing will be required even if you do not wish to be heard. In that case, you will be notified of the hearing date.)

(*If this order is made while you and the applicant are living in the same dwellinghouse, this order will expire—

• (a) on its discharge by the court (although the order may still become final, or be confirmed by the court, as set out above); or

• (b) on the discharge of a temporary protection order made in conjunction with this order; or

• (c) if no protection order has been made, and this order is not sooner discharged, 7 days after this order is made.)

You (or any other party) can apply to the court at any time—

• (a) to extend or reduce the period for which this order is in force; or

• (b) to vary or discharge any terms and conditions imposed by the court; or

• (c) to discharge this order.

If you breach this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove you from the property.

If you stay or go on to the property in breach of this order, you may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order has been made without notice first being given to the respondent.

This order is a temporary order.

(*If the respondent does nothing after being served, this order will (subject to notice being given to other persons with an interest in the property) automatically become a final order 3 months after the date on which it was made. You will then be sent a copy of the final order.

The respondent may, however, give notice that he or she wishes to dispute this order. In that case, a hearing will be held, and you will be notified of the hearing date.)

(*The court has directed that a hearing be held in relation to (*the whole of this order) (*specified parts of this order).

You are entitled to appear or be represented at the hearing to present your case to satisfy the court that (*the order should be made final) (*the parts of the order in relation to which the hearing is required should be part of the final order. If the respondent does nothing, then (subject to action being taken by another person with an interest in the property) the parts of the order in relation to which a hearing is not required will become final 3 months after the date on which this order was made, and the court may confirm the other parts of the order at the hearing.))

(*If another person who has an interest in the property and who has been given notice wishes to be heard, a hearing will be required, even if the respondent does not wish to be heard. In that case, you will be notified of the hearing date.)

(*If this order is made while you and the respondent are living in the same dwellinghouse, this order will expire—

• (a) on its discharge by the court (although the order may still become final, or be confirmed by the court, as set out above); or

• (b) on the discharge of a temporary protection order made in conjunction with this order; or

• (c) if no protection order has been made, and this order is not sooner discharged, 7 days after this order is made.)

You (or any other party) can apply to the court at any time—

• (a) to extend or reduce the period for which this order is in force; or

• (b) to vary or discharge any terms and conditions imposed by the court; or

• (c) to discharge this order.

If the respondent breaches this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove the respondent from the property.

If the respondent stays or goes on to the property in breach of this order, the respondent may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 18: amended, on 1 October 2008, pursuant to section 116(a)(ii) of the Policing Act 2008 (2008 No 72).

Section 53, Domestic Violence Act 1995

*Upon application the court makes an occupation order against [full name], the respondent.

*Upon application without notice the court made a temporary occupation order against [full name], the respondent, on [date], which order is now final (*in whole) (*in part) (*with modifications) (*without modifications).

The court orders that [full name], the applicant, is entitled, to the exclusion of the respondent, to personally occupy the dwellinghouse at [full address], together with any land, buildings, or improvements appurtenant to the dwellinghouse which are used, or ordinarily would be used, for the purposes of a household.

*The court directs that the applicant is entitled to occupy the dwellinghouse for the period from ....... to .......

*The court also imposes the following terms and conditions relating to the occupation of the dwellinghouse: [set out any terms and conditions imposed].

This order is a final occupation order that lasts for the period specified in the order or, where no period is specified, indefinitely.

You (or any other party) can apply to the court at any time—

• (a) to extend or reduce the period for which this order is in force; or

• (b) to vary or discharge any terms and conditions imposed by the court; or

• (c) to discharge this order.

If you breach this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove you from the property.

If you stay or go on to the property in breach of this order, you may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order is a final occupation order that lasts for the period specified in the order or, where no period is specified, indefinitely.

You (or any other party) can apply to the court at any time—

• (a) to extend or reduce the period for which this order is in force; or

• (b) to vary or discharge any terms and conditions imposed by the court; or

• (c) to discharge this order.

If the respondent breaches this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove the respondent from the property.

If the respondent stays or goes on to the property in breach of this order, the respondent may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 19: amended, on 1 October 2008, pursuant to section 116(a)(ii) of the Policing Act 2008 (2008 No 72).

Section 57, Domestic Violence Act 1995

Upon application without notice the court makes a temporary tenancy order against [full name], the respondent.

The court orders—

• (a) that the tenancy of the dwellinghouse at [full address] is vested in [full name], the applicant, upon and subject to the terms and conditions of the tenancy in force on [date on which order is made]; and

• (b) that the respondent ceases to be a tenant.

The court directs that there be a hearing in relation to this order.

I appoint [date] at ... am (pm) at the District Court at [place] for this hearing.

The applicant has made an application to the court, and this order has been made without notice first being given to you. A copy of the application and related papers—

• *(a) accompany this order; or

• *(b) will be served on you shortly; or

• *(c) may be obtained from (*the court that made the order) (*[specify place]).

This order is a temporary order.

(*If you do nothing after being served, this order will (subject to notice being given to other persons with an interest in the property) automatically become a final order 3 months after the date on which it was made. If you wish to dispute this order, you must notify the court as soon as possible.)

(*The court has directed that a hearing be held in relation to this order. This hearing will take place whether or not you wish to appear. If you wish to dispute any part of the order, you must notify the court as soon as possible.

If you do nothing, the court may make a final order in your absence.)

(*If another person who has an interest in the property and who has been given notice wishes to be heard, a hearing will be required even if you do not wish to be heard. In that case, you will be notified of the hearing date.)

(*If this order is made while you and the applicant are living in the same dwellinghouse, this order will expire—

• (a) on its discharge by the court (although the order may still become final, or be substituted by a final order, as set out above); or

• (b) on the discharge of a temporary protection order made in conjunction with this order; or

• (c) if no protection order has been made, and this order is not sooner discharged, 7 days after this order is made.)

You (or any other party) can apply to the court at any time to discharge this order and revest the tenancy. The court cannot vary the terms and conditions of the tenancy itself.

If you breach this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove you from the property.

If you stay or go on to the property in breach of this order, you may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order has been made without notice first being given to the respondent.

This order is a temporary order.

(*If the respondent does nothing after being served, this order will (subject to notice being given to other persons with an interest in the property) automatically become a final order 3 months after the date on which it was made. You will then be sent a copy of the final order.

The respondent may, however, give notice that he or she wishes to dispute this order. In that case, a hearing will be held, and you will be notified of the hearing date.)

(*The court has directed that a hearing be held in relation to this order. You are entitled to appear or be represented at the hearing to present your case to satisfy the court that the order should be made final.)

(*If another person who has an interest in the property and who has been given notice wishes to be heard, a hearing will be required, even if the respondent does not wish to be heard. In that case, you will be notified of the hearing date.)

(*If this order is made while you and the respondent are living in the same dwellinghouse, this order will expire—

• (a) on its discharge by the court (although the order may still become final, or be substituted by a final order, as set out above); or

• (b) on the discharge of a temporary protection order made in conjunction with this order; or

• (c) if no protection order has been made, and this order is not sooner discharged, 7 days after this order is made.)

You (or any other party) can apply to the court at any time to discharge this order and revest the tenancy. The court cannot vary the terms and conditions of the tenancy itself.

If the respondent breaches this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove the respondent from the property.

If the respondent stays or goes on to the property in breach of this order, the respondent may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 20: amended, on 1 October 2008, pursuant to section 116(a)(ii) of the Policing Act 2008 (2008 No 72).

Section 57, Domestic Violence Act 1995

*Upon application the court makes a tenancy order against [full name], the respondent.

*Upon application without notice the court made a temporary tenancy order against [full name], the respondent, on [date], which order is now final.

The court orders—

• (a) that the tenancy of the dwellinghouse at [full address] is vested in [full name], the applicant, upon and subject to the terms and conditions of the tenancy in force on [date on which order is made]; and

• (b) that the respondent ceases to be a tenant.

This order is a final tenancy order that lasts indefinitely. The applicant becomes the tenant of the dwellinghouse to which this order relates, subject to the terms and conditions of the tenancy in force at the time this order is made. You cease to be a tenant.

You (or any other party) can apply to the court at any time to discharge this order and revest the tenancy. The court cannot vary the terms and conditions of the tenancy itself.

If you breach this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove you from the property.

If you stay or go on to the property in breach of this order, you may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

This order is a final tenancy order that lasts indefinitely. You become the tenant of the dwellinghouse to which this order relates, subject to the terms and conditions of the tenancy in force at the time this order is made. The respondent ceases to be a tenant.

You (or any other party) can apply to the court at any time to discharge this order and revest the tenancy. The court cannot vary the terms and conditions of the tenancy itself.

If the respondent breaches this order by staying on the property, a warrant may be issued by a District Court authorising a bailiff or constable to remove the respondent from the property.

If the respondent stays or goes on to the property in breach of this order, the respondent may also commit the offence of trespass. That offence carries a maximum penalty of 3 months' imprisonment.

If you need help, consult a lawyer or contact a District Court office immediately.

The office of the District Court is open from ... to ... on Mondays to Fridays inclusive.

• Schedule 1 form DV 21: amended, on 1 October 2008, pursuant to section 116(a)(ii) of the Policing Act 2008 (2008 No 72).

Section 63, Domestic Violence Act 1995

Having made—

• *(a) an occupation order; or

• *(b) a tenancy order—

on [date] in favour of [full name], the applicant, against [full name], the respondent, the court, upon application without notice, makes a temporary ancillary furniture order.

The court orders that the applicant is entitled, to the exclusion of the respondent, to the possession of—

• *(a) all of the furniture, household appliances, and household effects in the dwellinghouse to which the (*occupation order) (*tenancy order) relates, which is situated at [full address]; or

• *(b) the following furniture, household appliances, and household effects in the dwellinghouse to which the (*occupation order) (*tenancy order) relates, which is situated at [full address]: [specify the items. It is not necessary to specify every item as long as the items to which the order relates are readily ascertainable from the terms of this order].

*The court directs that this order continues in force for ....... [specify duration if order made for specific period].

The court also imposes the following terms and conditions relating to the furniture, household appliances, and household effects to which this order relates: [set out any terms and conditions imposed].

The court directs that there be a hearing in relation to (*the whole of this order) (*the following parts of this order: [specify parts]).

I appoint [date] at ... am (pm) at the District Court at [place] for this hearing.

The applicant has made an application to the court, and this order has been made without notice first being given to you. A copy of the application and related papers—

• *(a) accompany this order; or