the offender must report in person to a probation officer in the probation area in which the offender resides as soon as practicable, and not later than 72 hours, after the start date of the sentence:

the offender must report to the probation officer as and when required to do so by the probation officer, and must notify the officer of his or her residential address and the nature and place of his or her employment when requested to do so:

the offender must not move to a new residential address in another probation area without the prior written consent of a probation officer:

if consent is given under paragraph (c), the offender must report in person to a probation officer in the new probation area in which the offender is to reside as soon as practicable, and not later than 72 hours, after the offender’s arrival in the new area:

if the offender intends to change his or her residential address within a probation area, the offender must give a probation officer reasonable notice before moving from his or her residential address (unless notification is impossible in the circumstances) and must advise the probation officer of the new address:

the offender must not reside at any address at which a probation officer has directed the offender not to reside:

the offender must, if a probation officer directs, allow the collection of biometric information:

the offender must not engage, or continue to engage, in any employment or occupation in which a probation officer has directed the offender not to engage or continue to engage:

the offender must not associate with any specified person, or with persons of any specified class, with whom a probation officer has, in writing, directed the offender not to associate:

the offender must take part in a rehabilitative and reintegrative needs assessment if and when directed to do so by a probation officer.

the offender must report in person to a probation officer in the probation area in which the offender resides as soon as practicable, and not later than 72 hours, after the start date of the sentence:

the offender must report to a probation officer at least once in each week during the first 3 months of the sentence, at least once in each month during the remainder of the sentence, and otherwise as and when required to do so by a probation officer:

the offender must notify a probation officer of his or her residential address and the nature and place of his or her employment when asked to do so:

the offender must not move to a new residential address in another probation area without the prior written consent of a probation officer:

if consent is given under paragraph (d), the offender must report in person to a probation officer in the new probation area in which the offender is to reside as soon as practicable, and not later than 72 hours, after the offender’s arrival in the new area:

if an offender intends to change his or her residential address within a probation area, the offender must give a probation officer reasonable notice before moving from his or her residential address (unless notification is impossible in the circumstances) and must advise the probation officer of the new address:

the offender must not reside at any address at which a probation officer has directed the offender not to reside:

the offender must not leave or attempt to leave New Zealand without the prior written consent of a probation officer:

the offender must, if a probation officer directs, allow the collection of biometric information:

the offender must not engage, or continue to engage, in any employment or occupation in which a probation officer has directed the offender not to engage or continue to engage:

the offender must not associate with any specified person, or with persons of any specified class, with whom a probation officer has, in writing, directed the offender not to associate:

the offender must take part in a rehabilitative and reintegrative needs assessment if and when directed to do so by a probation officer.

during the curfew period the offender must not, at any time, leave the curfew address except in the following circumstances:

• to seek urgent medical or dental treatment; or

• to avoid or minimise a serious risk of death or injury to the offender or any other person; or

• with the approval of a probation officer (if the offender is also serving a sentence of supervision or intensive supervision)—

  • to seek or engage in employment; or

  • to attend training or other rehabilitative or reintegrative activities or programmes; or

  • to attend a restorative justice conference or other process relating to the offender’s offending; or

  • to carry out any undertaking arising from any restorative justice process; or

  • with the approval of a probation officer and subject to any conditions imposed by the probation officer, on humanitarian grounds:

during the curfew period the offender is under the supervision of a probation officer and must co-operate with the probation officer and comply with any lawful direction given by that probation officer:

the offender must report in person to a probation officer in the probation area in which the offender resides as soon as practicable, and not later than 24 hours, after the start date of the sentence, unless the 24 hours elapses on a weekend or public holiday, in which case the offender must report on the next working day:

the offender must report to a probation officer as and when required to do so by the probation officer, and must notify the probation officer of his or her residential address, any change to that address, and the nature and place of his or her employment when asked to do so:

the offender must not leave or attempt to leave New Zealand without the prior written consent of a probation officer:

the offender must, if a probation officer directs, allow the collection of biometric information:

the offender must keep in his or her possession this curfew order and, if requested to do so by a constable or a probation officer, must produce the order for inspection:

the offender must, if required to submit to the electronic monitoring of his or her sentence, remain during the curfew period within the area defined by the probation officer:

the offender must, when required to do so by a probation officer, submit to the electronic monitoring of compliance with the conditions of his or her sentence, which may require the offender to be connected to electronic monitoring equipment throughout the sentence term and not just throughout the curfew period.

the offender is under the supervision of a probation officer and must co-operate with the probation officer and comply with any lawful direction given by that probation officer:

the offender must not leave the home detention residence at any time except in the circumstances set out in section 80C(3), (4), and (5) of the Sentencing Act 2002 (see below):

the offender must keep in his or her possession this order and, if requested to do so by a constable or a probation officer, must produce the order for inspection:

the offender must not leave or attempt to leave New Zealand without the prior written consent of a probation officer:

the offender must, if a probation officer directs, allow the collection of biometric information:

the offender must, when required by a probation officer, submit to the electronic monitoring of compliance with his or her detention conditions:

the offender must, if required to submit to the electronic monitoring of his or her sentence, remain within the area defined by the probation officer:

the offender must not engage, or continue to engage, in any employment or occupation in which a probation officer has directed the offender not to engage or continue to engage:

the offender must not associate with any specified person, or with persons of any specified class, with whom the probation officer has, in writing, directed the offender not to associate:

the offender must take part in a rehabilitative and reintegrative needs assessment if and when directed to do so by a probation officer.

to seek urgent medical or dental treatment:

to avoid or minimise a serious risk of death or injury to the offender or any other person; or

with the approval of a probation officer—

• to comply with any special condition; or

• to seek or engage in employment; or

• to attend training or other rehabilitative or reintegrative activities or programmes; or

• to attend a restorative justice conference or other process relating to the offender’s offending; or

• to carry out any undertaking arising from any restorative justice process; or

• for any other purpose specifically approved by the probation officer.

the offender must report to a probation officer as and when required to do so by a probation officer and must notify the probation officer of his or her residential address and the nature and place of his or her employment when asked to do so:

the offender must not move to a new residential address in another probation area without the prior written consent of the probation officer:

if consent is given under paragraph (b), the offender must report in person to a probation officer in the new probation area in which the offender is to reside as soon as practicable, and not later than 72 hours, after the offender’s arrival in the new area:

if an offender intends to change his or her residential address within a probation area, the offender must give the probation officer reasonable notice before moving from his or her residential address (unless notification is impossible in the circumstances) and must advise the probation officer of the new address:

the offender must not reside at any address at which a probation officer has directed the offender not to reside:

the offender must not leave or attempt to leave New Zealand without the prior written consent of a probation officer:

the offender must, if a probation officer directs, allow the collection of biometric information:

the offender must not engage, or continue to engage, in any employment or occupation in which the probation officer has directed the offender not to engage or continue to engage:

the offender must not associate with any specified person, or with persons of any specified class, with whom the probation officer has, in writing, directed the offender not to associate:

the offender must take part in a rehabilitative and reintegrative needs assessment if and when directed to do so by a probation officer.

[Full name, address, occupation] (the offender) was, on [date], convicted of [offence] by the [specify] Court at [place] and on [date] was sentenced to imprisonment for a term of [specify period]/imprisonment for life*.

For this paragraph select the statement that applies.

Section 86(2) of the Sentencing Act 2002 applies to the offender as I am satisfied that the period of imprisonment otherwise applicable to the offender’s determinate sentence under section 84(1) of the Parole Act 2002 is insufficient for all or any of the following purposes:

• holding the offender accountable for the harm done to the victim and the community by the offending:

• denouncing the conduct in which the offender was involved:

• deterring the offender or other persons from committing the same or a similar offence:

• protecting the community from the offender.

I am satisfied that section 86P(2)/86S(2)* of the Sentencing Act 2002 applies to the offender.

Section 103(1)(a) of the Sentencing Act 2002 applies to the offender, and I consider that the minimum term of imprisonment specified below is necessary to satisfy all or any of the following purposes:

• holding the offender accountable for the harm done to the victim and the community by the offending:

• denouncing the conduct in which the offender was involved:

• deterring the offender or other persons from committing the same or a similar offence:

• protecting the community from the offender.

The court orders, under section 86/86P(2)/86S(2)/103* of the Sentencing Act 2002, that the offender must serve a minimum period of imprisonment of [specify period].

[Full name, address, occupation] (the offender) was, on [date], convicted of [offence] by the [specify] Court at [place] and was this day/on [date]* sentenced to preventive detention.

For this paragraph select the statement that applies.

I have considered the matters referred to in section 89(2) of the Sentencing Act 2002 and consider that a minimum period of imprisonment of [specify period] is appropriate.

I am satisfied that section 86R(6) of the Sentencing Act 2002 applies to the offender and consider that a minimum period of imprisonment of [specify period] is appropriate.

The court orders, under section 89 of the Sentencing Act 2002, that the offender serve a minimum period of imprisonment of [specify period].

the standard release conditions set out in section 14 of the Parole Act 2002, which expire on [date]:

the special conditions listed below, which expire on [date].

[list special conditions]

the standard release conditions set out in section 14 of the Parole Act 2002 apply until they expire on [specify]:

the special conditions listed below apply until they expire on [specify].

[list special conditions]

The offender must not—

The protected person can suspend or reinstate the no-contact condition by giving or cancelling consent to contact.

The protected person’s consent is valid only if given in writing or in a digital communication, but the protected person may withdraw consent at any time and in any way.

The protected person cannot consent to any contact inconsistent with—

Contact by the offender with the protected person is authorised, and not in breach of the no-contact condition, if the contact is—

The offender—

On the making of this protection order, any firearms licence held by the offender is deemed to be revoked.

Note: The Family Violence Act 2018 defines a weapon as any firearm, airgun, pistol, prohibited magazine, prohibited part, restricted weapon, ammunition, or explosive, as those terms are defined in the Arms Act 1983.

[Note: If the court has modified the terms of the standard condition relating to weapons, or directed that the standard condition relating to weapons is not a condition of the order (whether absolutely or only to the extent that the order relates to the respondent), set out the terms of the court’s decision.]

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

*Special conditions to protect the protected person from further violence by the offender:

*Special conditions to address the inflicting of family violence against protected people who are particularly vulnerable (for example, due to age, disability, or health condition):

*Person who may consent to contact on behalf of the protected person and to withdraw such consent [name of person who may consent]:

*Other [insert any other special condition]:

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

The court directs [full name of offender] to undertake an assessment for a non-violence programme, and attend a non-violence programme, provided by a service provider, that an assessor determines is an appropriate non-violence programme for the offender to attend.*

The court directs [full name of offender] to undertake an assessment for prescribed services, and engage with any prescribed standard service, provided by a service provider, that an assessor determines may be appropriate for and may benefit the offender.*

The Registrar of the court will arrange for the offender to be referred to an assessor, and the offender must meet with the assessor so that the assessor may—

If there is an appropriate non-violence programme for the offender to attend, the service provider of that programme will settle in writing with the offender the terms of attendance, which must include—

Before providing a prescribed standard service to an offender directed to engage with the service, the service provider must settle in writing with the offender the terms of the offender’s engagement with the service.*

for the modification or discharge of the standard condition about weapons. (The Family 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 family violence):

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

for this order to be discharged.

doing an act in contravention of this order; or

failing to comply with any condition of this order; or

contravening, or failing to comply with any term and condition of, a related occupation order (for example, by failing to leave the dwellinghouse to which the order relates); or

contravening a related tenancy order (for example, by failing to leave the dwellinghouse to which the order relates); or

contravening, or failing to comply with any term and condition of, a related ancillary furniture order (for example, by preventing possession and use of all or any items to which the order relates); or

contravening, or failing to comply with any term and condition of, a related furniture order (for example, by preventing possession and use of all or any items to which the order relates).

to undertake an assessment for, and attend, a programme; or

to undertake an assessment for, or engage with, a prescribed service.

[Full name, address, occupation, date of birth] (the offender) was convicted on [date] of an offence against section 36A(1)(a)/36A(1)(c)* of the Land Transport Act 1998 involving this vehicle by the High Court/District Court* at [place].

Omit this paragraph if it does not apply.

The following substitute/substitutes* for the offender has/have* an interest in the vehicle:

[For each substitute, specify full name, address, occupation, and date of birth.]

This is the second illegal street racing offence committed by the offender within 4 years.

On [date], the High Court/District Court* at [place] convicted the offender of an offence against section 36A(1)(a)/36A(1)(c)* of the Land Transport Act 1998 (the previous offence).

The previous offence was committed on [date].

You are warned that the court may, in accordance with section 129A of the Sentencing Act 2002, order that any vehicle that the offender/a substitute* owns or in which the offender/a substitute* has an interest (including a vehicle other than the vehicle involved in the current offence or the previous offence) be confiscated and destroyed if—

[Full name, address, occupation, date of birth] (the offender) was convicted on [date] of [offence] (the current offence) by the High Court/District Court* at [place].

The current offence was committed on [date].

At the material time, the offender was driving or in charge of the following vehicle that you are believed to own or have an interest in:

Make and model:

Year of first registration:

Registration number:

The court is not satisfied that any of the exceptions from service of a written caution in section 129B(3) of the Sentencing Act 2002 apply to you.*

You are warned that the court may order that any vehicle that you own or in which you have an interest (including a vehicle other than the vehicle involved in the current offence) be confiscated in accordance with section 128 of the Sentencing Act 2002 if—

For this paragraph select the statement that applies.

The offence committed by the offender on this occasion is an illegal street racing offence.

The offence committed by the offender on this occasion is—

On [date], the High Court/District Court* at [place] convicted the offender of an offence against section 36A(1)(a)/36A(1)(c)* of the Land Transport Act 1998 (the previous offence).

The previous offence was committed on [date].

For this paragraph select the statement that applies.

The offender will have committed 3 illegal street racing offences within 4 years if the offender commits 2 further illegal street racing offences within 4 years after [date of commission of current offence].

The offender will have committed 3 illegal street racing offences within 4 years if the offender commits 1 further illegal street racing offence within 4 years after [date of commission of previous offence].

You are warned that the court may order that any vehicle that you own or in which you have an interest (including a vehicle other than the vehicle involved in the current offence) may be confiscated and destroyed in accordance with section 129A of the Sentencing Act 2002 if—

the motor vehicle was stolen or converted at the material time:

you did not own or have an interest in the motor vehicle at the material time:

you are a secured party under a security agreement relating to the motor vehicle or the lessor of the motor vehicle under a lease, but have no relationship of another kind with the offender:

the motor vehicle was let on hire at the material time in accordance with a rental service licence under the Land Transport Act 1998.

[Full name, address, occupation, date of birth] (the offender) was convicted on [date] of [offence] by the High Court/District Court* at [place].

Omit this paragraph if it does not apply.

At the material time the offender was driving or in charge of a vehicle in which [full name, address, occupation, date of birth] (the substitute) has an interest.

On [date], an order was made by the High Court/District Court* at [place] for the confiscation of the following motor vehicle in which the offender/substitute* has an interest:

Make and model:

Year of first registration:

Registration number:

Under the confiscation order, the offender/substitute* was required to surrender the motor vehicle to a constable or bailiff or the Registrar at [place, date, time].

The offender/substitute* has failed to surrender the motor vehicle.

I direct you, unless the motor vehicle is sooner surrendered to a constable or bailiff or the Registrar, to seize the motor vehicle and to deliver it into the custody of the Registrar of the High Court/District Court* at [place].

On [date], an order was made by the High Court/District Court* at [place] for the confiscation and destruction of the following motor vehicle:

Make and model:

Year of first registration:

Registration number:

The vehicle was sold to [full name, address, occupation, date of birth] (the purchaser) on [date].

The sale was subject to a condition that the vehicle be dismantled for any saleable parts and the remainder destroyed to the satisfaction of the Registrar within 30 working days or any longer period specified in writing by the Registrar.

The purchaser did not comply with that condition of sale and the person in possession of the vehicle was required to surrender the vehicle to a constable or bailiff or the Registrar at [place, date, time].

The person in possession of the vehicle has failed to surrender the motor vehicle.

I direct you, unless the motor vehicle is sooner surrendered to a constable or bailiff or the Registrar, to seize the motor vehicle and to deliver it into the custody of the Registrar of the High Court/District Court* at [place].

On [date], an order was made by the High Court/District Court* at [place] for the confiscation of the following motor vehicle:

Make and model:

Year of first registration:

Registration number:

The vehicle was transferred to [full name, address, occupation, date of birth] (the secured party) on [date].

The transfer was made under a court order that the vehicle be sold within a reasonable period.

The secured party has not complied with that order and the person in possession of the vehicle was required to surrender the vehicle to a constable or bailiff or the Registrar at [place, date, time].

The person in possession of the vehicle has failed to surrender the motor vehicle.

I direct you, unless the motor vehicle is sooner surrendered to a constable or bailiff or the Registrar, to seize the motor vehicle and to deliver it into the custody of the Registrar of the High Court/District Court* at [place].

[Full name, address, occupation] (the offender) was, on [date], convicted of [offence] by the [specify] Court at [place] and on [date] was sentenced to imprisonment for a term of [specify period]/imprisonment for life*.

For this paragraph select the statement that applies.

I am satisfied that section 86O(2) of the Sentencing Act 2002 applies to the offender.

I am satisfied that section 86R(3) of the Sentencing Act 2002 applies to the offender.

I consider that section 103(2A) of the Sentencing Act 2002 applies to the offender and no minimum term of imprisonment would be sufficient to satisfy any or all of the following purposes:

• holding the offender accountable for the harm done to the victim and the community by the offending:

• denouncing the conduct in which the offender was involved:

• deterring the offender or other persons from committing the same or a similar offence:

• protecting the community from the offender.

The court orders, under section 86O(2)/86R(3)/103(2A)* of the Sentencing Act 2002, that the offender must serve the full term of imprisonment.

On [date], you were sentenced for the following qualifying offence(s): [list offences].

For this paragraph select the statement that applies.

You have been sentenced to imprisonment for a term of [specify period of sentence for relevant qualifying offence(s)].

You have been sentenced to imprisonment for a term of [specify period of sentence for relevant qualifying offence(s)], cumulative on [specify cumulative sentences] for those offences.

You have been sentenced to [specify indeterminate sentence for relevant qualifying offence(s)].

On [date], I gave you a first warning, in which I warned you of the possible consequences if you subsequently receive a qualifying sentence for any qualifying offence committed after that first warning.

This notice records in writing the possible consequences that I explained to you.

A record of the first warning will now appear in the permanent court record and in your criminal record.

you will have to serve that sentence without parole (unless it is a sentence of life imprisonment or preventive detention); and

you will be given another warning, called a subsequent warning.

when you are sentenced, the Judge must sentence you to imprisonment for life with a longer minimum period of imprisonment than would otherwise apply; and

you will be given another warning, called a subsequent warning.

On [date], you were sentenced for the following qualifying offence(s): [list offences].

For this paragraph select the statement that applies.

You have been sentenced to imprisonment for a term of [specify period of sentence for relevant qualifying offence(s)].

You have been sentenced to imprisonment for a term of [specify period of sentence for relevant qualifying offence(s)], cumulative on [specify cumulative sentences] for those offences.

You have been sentenced to [specify indeterminate sentence for relevant qualifying offence(s)].

You had a record of a first warning at the time you committed the offence(s).

On [date], I gave you a subsequent warning, in which I warned you of the possible consequences if you receive a further qualifying sentence for any qualifying offence committed after that subsequent warning.

This notice records in writing the possible consequences that I explained to you.

A record of the subsequent warning will now appear in the permanent court record and in your criminal record.

the term of imprisonment will be the maximum term for that offence (unless the offence is manslaughter or you pleaded guilty to the offence, in which case other prescribed minimum terms apply); and

you must serve the sentence without parole; and

you will be given another subsequent warning.

when you are sentenced, the Judge must sentence you to imprisonment for life with a longer minimum period of imprisonment than would otherwise apply; and

you will be given another subsequent warning.

On [date], you were sentenced for the following qualifying offence(s): [list offences].

On [date], the court gave you a first/subsequent* warning, which warned you of the possible consequences if you were convicted of and sentenced for another qualifying offence committed after that warning.

For this paragraph select the statement that applies.

On [date], your appeal against your conviction(s) for the offence(s) for which you received your first/subsequent* warning was allowed and your conviction was/convictions were* quashed or set aside.

On [date], your appeal against your sentence imposed for the offence(s) for which you received your first/subsequent* warning was allowed, your sentence was quashed or set aside, and a qualifying sentence/sentence of imprisonment of more than 12 months but not more than 24 months* was not imposed in substitution.

On [date], your sentence imposed for the offence(s) for which you received your first/subsequent* warning was cancelled and substituted with a sentence of home detention.

On [date], the court imposed a new sentence under section 180 of the Criminal Procedure Act 2011 for the offence to which the first/subsequent* warning relates and the new sentence is not a qualifying sentence/sentence of imprisonment of more than 12 months but not more than 24 months*.

On [date], you were granted a free pardon for the offence to which the first/subsequent* warning relates.

On [date], you fulfilled the conditions of a conditional pardon and are not required to serve a qualifying sentence/sentence of imprisonment of more than 12 months* for the offence to which the first/subsequent* warning relates.

You therefore no longer have a record of a first/subsequent* warning in relation to the offence(s) listed above.

On [date], you were sentenced for the following qualifying offence(s): [list offences].

On [date], you were given a subsequent warning because you had a record of a first warning when you committed the offence(s).

For this paragraph select the statement that applies.

On [date], your appeal against your conviction(s) for the offence(s) for which you received your first warning was allowed and your conviction was/convictions were* quashed or set aside.

On [date], your appeal against your sentence imposed for the offence(s) for which you received your first warning was allowed, that sentence was quashed or set aside, and a qualifying sentence was not imposed in substitution.

On [date], your appeal against your sentence imposed for the stage-2 offence(s) for which you received your subsequent warning was allowed, that sentence was quashed or set aside, and a sentence of imprisonment of more than 12 months but not more than 24 months was imposed in substitution.

On [date], your sentence imposed for the offence(s) for which you received your first warning was cancelled and substituted with a sentence of home detention.

On [date], the court imposed a new sentence under section 180 of the Criminal Procedure Act 2011 for the offence to which your first warning relates and the new sentence is not a qualifying sentence.

On [date], you were granted a free pardon for the offence to which your first warning relates.

On [date], you fulfilled the conditions of a conditional pardon and are not required to serve a qualifying sentence for the offence to which your first warning relates.

For this paragraph select the statement that applies.

The court ordered that a first warning replace your subsequent warning. That first warning is treated as having taken effect on [date that the replaced subsequent warning took effect].

The court ordered that a first warning replace your earliest subsequent warning/warnings* (being any subsequent warning that took effect on the earliest date on which you had a subsequent warning). That first warning is treated as having taken effect on [date on which the replaced subsequent warning(s) took effect].

This notice records in writing the possible consequences if you are convicted and sentenced for another qualifying offence committed after that first warning.

you will have to serve that sentence without parole (unless it is a sentence of life imprisonment or preventive detention); and

you will be given another warning, called a subsequent warning.

when you are sentenced, the Judge must sentence you to imprisonment for life with a longer minimum period of imprisonment than would otherwise apply; and

you will be given another warning, called a subsequent warning.

On [date], you were sentenced for the following qualifying offence(s): [list offences].

For this paragraph select the statement that applies.

On that occasion, this court omitted to give you a warning required under section 86K/86KA/86L* of the Sentencing Act 2002.

That sentence (the new sentence) was imposed in substitution for a previous sentence, which was quashed or set aside on an appeal. Because you were not before the court that imposed the new sentence, the court did not give a warning under section 86K/86KA/86L* of the Sentencing Act 2002.

The court that imposed the new sentence remitted the proceeding to this court in order for you to be given that warning.

You are summoned to appear on [date and time] in [specify] Court at [place] to be given that warning.

If you fail to appear before this court in answer to this summons at the above specified time and place, a warrant will be issued for your arrest.

On [date], [full name, address, and occupation of offender] (the offender) was sentenced for the following qualifying offence(s): [list offences].

For this paragraph select the statement that applies.

On that occasion, this court omitted to give the offender a warning required under section 86K/86KA/86L* of the Sentencing Act 2002.

That sentence (the new sentence) was imposed in substitution for a previous sentence, which was quashed or set aside on an appeal. Because the offender was not before the court that imposed the new sentence, the court did not give a warning under section 86K/86KA/86L* of the Sentencing Act 2002.

The court that imposed the new sentence remitted the proceeding to this court in order for that warning to be given.

On [date], a summons was issued to the offender requiring the offender to appear in this court on [date] to be given a warning under section 86K/86KA/86L* of the Sentencing Act 2002, but the offender failed to appear before this court in answer to the summons.

I direct you to arrest the offender and bring the offender before this court as soon as possible so that the offender may be given that warning.

In the [specify] Court at [place, date], [offender’s full name] was convicted of the following qualifying instrument forfeiture offence(s): [specify].

[Prosecutor’s name and description] is of the opinion that the court should consider whether to make an instrument forfeiture order in respect of the following property used to commit, or to facilitate the commission of, the above qualifying instrument forfeiture offence(s): [details of property, including its value if known to the prosecutor, the names and identifying details of any persons (including persons other than the offender) who, to the knowledge of the prosecutor, have an interest in that property, and the nature and extent of that interest, and summarising how the property was, in the prosecutor’s opinion, used to commit, or to facilitate the commission of, the above qualifying instrument forfeiture offence(s)].

The prosecutor’s notice given under section 142B of the Sentencing Act 2002 by [prosecutor’s name and description] on [date] was considered by the court on [date].

For this paragraph select the statement that applies.

The court will on [date] consider making an instrument forfeiture order in respect of the property specified in that prosecutor’s notice.

The court is not of the opinion that it should consider making an instrument forfeiture order in respect of the property specified in that prosecutor’s notice.

Omit this paragraph if statement B is selected for paragraph 2.

You are directed—

Omit this paragraph if it does not apply.

In the [specify] Court at [place, date], [offender’s full name] was convicted of the following qualifying instrument forfeiture offence(s): [specify].

The court, in a document signed on [date], directed the prosecutor to issue and serve this notice that the following property may be made the subject of an instrument forfeiture order: [details of property specified in the prosecutor’s notice given under section 142B of the Sentencing Act 2002, including the names of any persons having an interest in that property and the nature and extent of that interest].

You may, within 10 working days of the date of this notice, apply to the court for relief.

The grounds on which you may apply to the court for relief are set out in section 77(1)(a) and (b) of the Criminal Proceeds (Recovery) Act 2009, and are that—

The court on [date] gave a direction under section 142C of the Sentencing Act 2002 relating to, and will on [date] consider making an instrument forfeiture order under section 142N of the Sentencing Act 2002 against, the following property: [specify].

The court by this order requires you to enter on the register a note of the fact that the court will consider whether an instrument forfeiture order may be made against that property.

You were required by an order of the court made under section 142D(2) of the Sentencing Act 2002 on [date] to make an entry on the register noting that the court was to consider whether an instrument forfeiture order under section 142N of the Sentencing Act 2002 may be made against the following property: [specify].

The court by this order requires you to cancel any entry made on the register in accordance with that order.

The court on [date] gave a direction under section 142C(a) of the Sentencing Act 2002 relating to, and will on [date] consider whether an instrument forfeiture order under section 142N of that Act may be made against, the following property: [details of property specified in the prosecutor’s notice given under section 142B of the Sentencing Act 2002, including the names of any persons having an interest in that property and the nature and extent of that interest, and summarising how, in the prosecutor’s opinion, the particular property was used to commit, or to facilitate the commission of, the particular qualifying instrument forfeiture offence(s)].

You are required by this direction to provide to the court before [deadline] further information about the following matter(s):

Select the paragraph(s) that apply.

The court on [date] gave a direction under section 142C of the Sentencing Act 2002 relating to, and will on [date] consider whether an instrument forfeiture order under section 142N of that Act may be made against, the following property: [details of property specified in the prosecutor’s notice given under section 142B of the Sentencing Act 2002].

You are required by this order to complete a declaration of ownership specifying the following matters:

For this paragraph omit any statement that does not apply.

At [date of offender’s conviction for the qualifying instrument forfeiture offence] [offender’s full name] owned, or had an interest in, the following property: [specify which, if any, of the property referred to in the order for declaration of ownership that the offender owned or had an interest in].

At [date of offender’s conviction for the qualifying instrument forfeiture offence] [offender’s full name] did not own or have an interest in the following property: [specify which, if any, of the property referred to in the order for declaration of ownership that the offender owned or had an interest in].

For this paragraph omit any statement that does not apply.

At [date of offender’s conviction for the qualifying instrument forfeiture offence] [full name] owned, or had an interest in, the following property: [specify which, if any of the property referred to in the order for declaration of ownership that the person named owned or had an interest in and the nature of that interest].

At [date of offender’s conviction for the qualifying instrument forfeiture offence] no other person owned, or had an interest in, the following property: [specify which, if any of the property referred to in the order for declaration of ownership that no other person owned or had an interest in].

For this paragraph select the statement that applies.

[Offender’s full name] ceased to be the owner of, or to have an interest in, the following property at a time subsequent to the commission of the offence but before [date of offender’s conviction for the qualifying instrument forfeiture offence]: [specify the relevant property, referred to in the order for declaration of ownership, the offender’s ownership or interest in which was disposed of, the person to whom it was disposed of, the relationship of that person to the offender, and the consideration received by the offender].

There is no property that [offender’s full name] ceased to be the owner of, or to have an interest in, at a time subsequent to the commission of the offence but before [date of offender’s conviction for the qualifying instrument forfeiture offence].

At [place, date] the court made the following instrument forfeiture order under section 142N of the Sentencing Act 2002:

The following property is subject to this instrument forfeiture order and therefore, under section 70(1)(a) and (b) of the Criminal Proceeds (Recovery) Act 2009, vests in the Crown absolutely (subject to the interests protected by section 70(2) of that Act), and is in the Official Assignee’s custody and control: [specify the forfeited property in a comprehensive list, with a description adequate to identify each asset and, for property (other than money), specify (in accordance with section 142N(4) of the Sentencing Act 2002) the amount that the court considers to be the value of that property at the time this order is made].

Include this paragraph only if the court, by this order, makes or gives any further declarations or directions under section 142N(3)(a), (3)(b), or (5) of the Sentencing Act 2002 or section 71(1)(a) or (b) of the Criminal Proceeds (Recovery) Act 2009.

The court made or gave the following declarations or directions: [specify].

I am satisfied, on an application in writing made on oath under section 71(2) and (3) of the Criminal Proceeds (Recovery) Act 2009 by [name of applicant for warrant], an officer of the court, that there are reasonable grounds for believing that there is in or on/will come into or onto* [address or other description of the place of thing], while the warrant is in force, the following document(s) required to effect the transfer of property subject to an instrument forfeiture order: [specify].

This warrant authorises you—

The power to enter and search pursuant to this warrant may be exercised [specify the number of times that, or the period over which, the warrant may be executed] within [specify a period not exceeding 14 days] from the date of issue of this warrant.

Omit this paragraph if it does not apply.

This warrant is issued subject to the following condition(s): [specify any conditions specified by the Judge under section 116(3)(b) of the Criminal Proceeds (Recovery) Act 2009 (as applied by section 71(3) of that Act)].

[Full name] (the applicant) by this document applies to the court for an order for relief from an instrument forfeiture order that the court may make in respect of [specify property]/the court made on [date] in respect of [specify property]*.

For this paragraph select the statement that applies.

Statement A

This application for relief is made, in accordance with section 142L of the Sentencing Act 2002, on the ground set out in section 77(1)(a) of the Criminal Proceeds (Recovery) Act 2009. If the court is satisfied, following a hearing under section 142K of the Sentencing Act 2002, that the applicant has established on the balance of probabilities that the applicant has an interest in the following property to which the instrument forfeiture order relates, namely, [specify the property and the applicant’s interest, including whether the interest is severable and, if it is not, its value], and was not involved in the qualifying instrument forfeiture offence to which the instrument forfeiture order relates, the applicant will seek an order—

Statement B

This application for relief is made, in accordance with section 142M of the Sentencing Act 2002, on the ground (of undue hardship) set out in section 77(1)(b) of the Criminal Proceeds (Recovery) Act 2009. If, following a hearing under section 142K of the Sentencing Act 2002, the court is satisfied that, having regard to all the circumstances, undue hardship is reasonably likely to be caused to [full name of applicant or of another person (other than the offender)] by the operation of an instrument forfeiture order if relief is not granted, the applicant will seek—

The application is also made in reliance on [specify any other enactment, principle of law, or judicial decision relied on].

The application for an order for relief from an instrument forfeiture order made by [full name] on [date] was determined by the Honourable Justice/Judge* [name] on [date].

That application was determined, as required by section 142K of the Sentencing Act 2002, following a hearing concerning the instrument forfeiture order or a sentencing hearing held on [date(s)] at which the following people appeared: [List names of counsel or solicitors who represented the respective parties at the hearing and state whether any party appeared in person at the hearing.]

For this paragraph select the statement that applies.

Statement A

The application was made, in accordance with section 142L of the Sentencing Act 2002, on the ground set out in section 77(1)(a) of the Criminal Proceeds (Recovery) Act 2009. The court was satisfied that the applicant established on the balance of probabilities that the applicant has an interest in the following property to which the instrument forfeiture order relates, namely, [specify the property and the applicant’s interest, including whether the interest is severable and, if it is not, its value], and was not involved in the qualifying instrument forfeiture offence to which the instrument forfeiture order relates. The court therefore made the following order for relief from the instrument forfeiture order:

Statement B

The application was made, in accordance with section 142M of the Sentencing Act 2002, on the ground (of undue hardship) set out in section 77(1)(b) of the Criminal Proceeds (Recovery) Act 2009. The court was satisfied that, having regard to all the circumstances, undue hardship was reasonably likely to be caused to [full name of applicant or of another person (other than the offender)] by the operation of an instrument forfeiture order if relief was not granted. The court therefore made the following order(s) granting relief from the instrument forfeiture order:

[Full name] will on [date] apply to the court under section 142J(2)(c)(iii) of the Sentencing Act 2002 for leave to apply out of time for relief from an instrument forfeiture order.

The grounds on which the application is to be made are: [specify].