Magistrates Court (Civil Proceedings) Amendment Rules 2017 (WA)

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WESTERN 2991
AUSTRALIAN
GOVERNMENT
ISSN 1448-949X (print) ISSN 2204-4264 (online)
PRINT POST APPROVED PP665002/00041
PERTH, TUESDAY, 20 JUNE 2017 No. 117 SPECIAL

PUBLISHED BY AUTHORITY KEVIN J. McRAE, GOVERNMENT PRINTER AT 12.30 PM

© STATE OF WESTERN AUSTRALIA

Magistrates Court (Civil Proceedings) Act 2004

Magistrates Court (Civil Proceedings)

Amendment Rules 2017

Made by the Magistrates Court in accordance with the Magistrates Court
Act 2004 section 39.

1.             Citation

These rules are the Magistrates Court (Civil Proceedings)
Amendment Rules 2017.

2.             Commencement

These rules come into operation as follows —

(a) rules 1 and 2 — on the day on which these rules are published in the Gazette;
(b) the rest of the rules — on 1 July 2017.

3.             Rules amended

These rules amend the Magistrates Court (Civil Proceedings)
Rules 2005.

4.             Rule 131D inserted

At the end of Part 21 Division 1 insert:

131D. Forms under Restraining Orders Act 1997
(1) For the purposes of the Restraining Orders Act 1997,
the forms set out in Schedule 1 are prescribed in
relation to the matters specified in those forms.
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(2) Where a form is in parts, then only those parts of the
form that are relevant, taking into account the part
heading, need be used for a particular copy of the form,
or for a particular purpose.

5.             Schedule 1 inserted

After rule 138 insert:

Schedule 1 Forms prescribed for Restraining Orders
Act 1997

[r. 131D]

Table of forms

Forms about family violence restraining orders

Form Provisions of Act
1 Application for family violence restraining order Section 24A
2 Part A — Family violence restraining order Sections 29, 32, 43,
Part B — Information to be on the copy of order given to the 49 and 63

person who is bound by the order

Part C — Information to be on the respondent’s endorsed copy

Part D — Information to be on the copy of the order given to

the person protected by the order

Part E — Information to be on the proof of service copy

Part F — Details of family order

3 Conduct agreement order Sections 10H, 43
Part A — Conduct agreement order
Part B — Information to be on the copy of order given to the

person who is bound by the order

Part C — Information to be on the copy of the order given to

the person protected by the order

Part D — Information to be on the proof of service copy

Part E — Details of family order

4 Section 63A family violence restraining order Section 63A
Part A — Section 63A family violence restraining order
Part B — Information to be on the copy of the order given to

the person who is bound by the order

Part C — Information to be on the copy of the order given to

the person protected by the order

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Forms about violence restraining orders

Form Provisions of Act
5 Application for violence restraining order Section 25
6 Part A — Violence restraining order Sections 29, 32, 43,
Part B — Information to be on the copy of order given to the 49 and 63

person who is bound by the order

Part C — Information to be on the respondent’s endorsed copy

Part D — Information to be on the copy of the order given to

the person protected by the order

Part E — Information to be on the proof of service copy

Part F — Details of family order

7 Part A — Section 63A violence restraining order Section 63A
Part B — Information to be on the copy of the order given to

the person who is bound by the order

Part C — Information to be on the copy of the order given to

the person protected by the order

Forms about misconduct restraining orders

Form Provisions of Act
8 Application for misconduct restraining order Section 38
9 Part A — Misconduct restraining order Part 4 Divisions 1
Part B — Information to be on the copy of the order given to and 2, sections 49
the person who is bound by the order and 63

Part C — Information to be on the copy of the order given to

the person protected by the order

Part D — Information to be on the proof of service copy

Forms about telephone orders

Form Provisions of Act
10 Part A — Telephone order Section 23
Part B — Court copy of telephone order
Part C — Information to be on the copy of the order given to

the person who is bound by the order

Part D — Information to be on the respondent’s endorsed copy

Part E — Information to be on the copy of the order given to

the person protected by the order

Part F — Information to be on the proof of service copy

11 Restraining order record of telephone application Section 21(4)

Forms about variation and cancellation of orders

Form Provisions of Act
12 Part A — Application to vary or cancel a restraining order Section 45
Part B — Information to be on the copy of the application

given to the applicant

13 Part A — Summons to vary or cancel restraining order Section 47
Part B — Information to be on the proof of service copy
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Other forms

Form Provisions of Act
14 Restraining order made during other proceedings — Record of Section 63
proceedings
15 Part A — Interstate restraining order — Application to register Section 75(2)
Part B — Information to be on the copy of the application

given to the applicant

Part C — Information to be on the copy of the application

given to the Commissioner of Police

Part D — Information to be on the copy of the application

given to the interstate court where the interstate order

was made

16 Part A — Restraining order — Summons Sections 26(3)
Part B — Information to be on the proof of service copy and 39
17 Application to have final order under section 32(2) of the Act Section 32(5)
set aside
18 Application to have decision under section 42 of the Act set Section 43A
aside
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Form 1 Application for family violence restraining order

Number: Jurisdiction:

Restraining Orders Act 1997 s. 24A

Family violence restraining order

Location:

Application

Applicant Family name: Date of birth:
[If not the Other names:
person seeking Address: street:
to be protected]
suburb:  postcode:
Phone nos.: work:  home: mobile:
Person Family name: Date of birth:
seeking to be Other names:
protected Address: street:
suburb:  postcode:
Phone nos.:
work:  home: mobile:
Respondent  Family name: Date of birth:
[Fill in as many  Other names:
details as you  Home street:
can address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Grounds for Give details of the respondent’s behaviour.
application
Family orders
Are there any current family orders relating to the respondent’s  Yes  No  Unknown
[If yes, see the rights in relation to children who may be affected by a
Details of family restraining order?
order Annexure]
Are there any current Family Court proceedings in which such  Yes  No  Unknown
orders are being sought?
Firearms
Does the respondent have a firearm or firearms licence?  Yes  No  Unknown
Does the respondent have access to a firearm at work?  Yes  No  Unknown
First hearing
Do you want the respondent to be present at the first hearing?  Yes  No
Applicant
Signature:  Date:
[Not essential if
applicant is a
police officer]
Hearing 
Court:  Date: Time:
[To be filled  Signature of registrar:
in by the 
court
Notification  I certify that on __ __/__ __/__ __ __ __ at _______ am/pm at ________________________
[To be filled  I notified the applicant of the hearing date.
in by the  Signature of registrar:
court
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Form 2 Family violence restraining order Part A Family violence restraining order

Restraining Orders Act 1997 Number:
s. 29, 32, 43, 49 and 63 Jurisdiction:
Family violence Location:
restraining order
Person who Family name: Date of birth:
is bound by Other names:
this order Home street:
address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Applicant Family name: Date of birth:
for the order
[If not the Other names:
person to be
protected]
Person Family name: Date of birth:
protected

Other names:

Type of The order is  for 72 hours or less  an interim order  a final order
order

Terms of this order

Information In addition to the terms of this order, the court informs you that the following
about behaviour and activities are unlawful:

unlawful behaviour and

activities
Order made
Date order made:  Time order made:
Registrar  Date:
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Form 2 Family violence restraining order

Part B Information to be on the copy of order given to the

person who is bound by the order

IMPORTANT INFORMATION

FOR PERSON BOUND BY THIS ORDER

If the order is for 72 hours or less

A family violence restraining order has been made against you for 72 hours or less on the terms set out on arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both. If you breach the order in the presence of a child with whom you are in a family relationship (e.g. your child, your partner’s child or a child who ordinarily resides with you) the court sentencing you will consider this
the front of this order. This order came into force when it was served on you, or at a later time, if this is
specified on the front of this order. You must comply with this order until the end of the period specified
in the order.
an aggravating factor.

Counselling, support and/or legal services may be of assistance to you.

If the order is an interim order

An interim family violence restraining order has been made against you on the terms set out on the front of of the other copy of this order and return it to the court within 21 days from the date this order was served on you. You will then not need to attend a final order hearing and the order will automatically become a final order which remains in force for the period specified in the order, or —
this order. This order came into force when it was served on you, or at a later time, if this is specified on
the front of this order, and it will remain in force until a final order is made or a court decides not to make
a final order. You must comply with this order at all times while it is in force.
You have an opportunity to object to the order before it becomes a final order.
If you want to object to this order being made final you must fill in the “Objection” section on the back
of the other copy of this order and return it to the court within 21 days from the date this order was served
on you. The court will then arrange a final order hearing at which it will consider anything you want to say
before deciding whether to make a final family violence restraining order. The court will let you know
where and when the final order hearing will be held.

(a)

if no period is specified and you are not a child, for 2 years from the date this interim order was served on you; or

(b)

if no period is specified and you are a child, for 6 months from the date this interim order was served on you.

If you were in prison at the time the court received your “Consent” form, the order will stay in force while

you are in prison and will expire 2 years after the date on which you are released from prison (or longer if
specified in the order).
If you do nothing and do not fill in and return the other copy of this order within 21 days the court will
assume that you do not object and the interim order will automatically become a final order.
Penalty: It is an offence to breach a family violence restraining order. If you breach this order you may be
arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.
Counselling, support and/or legal services may be of assistance to you.

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If the order is a final order

A final family violence restraining order has been made against you on the terms set out on the front of this order, and it will remain in force until it expires or is varied or cancelled by a court. You must comply with this order at all times while it is in force.

this order.
If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if it was made at a final order hearing and —
(a) you are not a child, 2 years after this final order comes into force; or
(b) you are a child, 6 months after this final order comes into force;

or

if it was a telephone order which became a final order because you did not object, 3 months, or any shorter period specified in the order, after the telephone order was served on you.

If you were in prison at the time this order was made, the order expires —

in the case of an order made at a final order hearing or an interim order which became the final order, 2 years after the date on which you are released from prison (or longer if specified in the order);
in the case of a telephone order which became the final order because you did not object, 3 months after the date on which you are released from prison (or shorter if specified in the order).

If, in the future, you want the order varied or cancelled you may apply to the court. If you would like more
information about doing this you should consult your lawyer or the registrar of the court.
Penalty: It is an offence to breach a family violence restraining order. If you breach this order you may be
arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

Additional information about conviction for breaching the order

Note 1:  If you are convicted of breaching this order, the fact that the person protected by the order aided
you in the breach is not a mitigating factor for the purposes of your sentencing (see the
Restraining Orders Act 1997 section 61B(2)).
Note 2:  If you are convicted of breaching this order and you have been convicted of at least 2 other
offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years
before your conviction for breaching this order, you will face a penalty that is or includes
imprisonment (or, if you are a child, detention) unless the court decides under section 61A(6) of
the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person protected by this order, request a copy of any affidavit received in evidence in relation
to this order the registrar of the court where the application for the order was made is to provide a copy of the

affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF YOU WERE
PRESENT IN COURT WHEN IT WAS MADE

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Form 2 Family violence restraining order

Part C — Information to be on the respondent’s endorsed copy of

the order

IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

For interim orders only

If you want to object to this order being made final you must fill in the

“Objection” section below and return it to the court within 21 days from the date this

order was served on you. The court will then arrange a final order hearing at which it
will consider anything you want to say before deciding whether to make a final
family violence restraining order. The court will let you know where and when the
final order hearing will be held.

If you do not object to this order being made final you must fill in the “Consent” section below and return this copy of the order to the court within 21 days of the date it was served on you.

If you do nothing and do not fill in and return this copy of the order to the court within 21 days this interim order will automatically become a final order.

Objection

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:
Will you be represented by a lawyer at the final order hearing?  Yes  No
If yes:  lawyer’s name:
lawyer’s firm:

How many witnesses (including yourself) do you intend to call? _________________

Does this interim order prevent you from —

going to where you normally live?  Yes  No
having contact with your children?  Yes  No
going to where you work or otherwise prevent
you from doing your job?  Yes  No
being in possession of a firearm which is
essential for your job?  Yes  No
Signature:  Date:

OR

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Consent

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:

I do not object to a final order being made on the same terms as this interim order. will automatically become a final order which will stay in force for —

(a) the period specified in the order; or

(b)

if no period is specified and I am not a child, for 2 years from the date on which this order was served on me; or

(c)

if no period is specified and I am a child, for 6 months from the date on which this order was served on me.

If I am in prison when the court receives this form, the order will stay in force while I am in
prison and for a further 2 years from the date on which I am released from prison (or longer if
specified in the order).

Signature:  Date:
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Form 2 Family violence restraining order

Part D Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON PROTECTED BY THIS ORDER

If the order is for 72 hours or less

A family violence restraining order has been made to protect you for 72 hours or less on the terms set out on the front of this order. This order will come into force when it is served on the person who is bound by this order, or at a later time, if this is specified on the front of this order. The person who is bound by this order must comply with this order until the end of the period specified in the order.

Penalty: It is an offence to breach a family violence restraining order. If the person bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

If the order is an interim order

An interim family violence restraining order has been made to protect you on the terms set out on the front final order.

of this order. This order will come into force when it is served on the person bound by this order, or at a
later time, if this is specified on the front of this order, and it will remain in force until a final order is
made or a court decides not to make a final order. The person who is bound by this order must comply
with this order at all times while it is in force.

If the person who is bound by this order does object you will need to attend a final order hearing. At that hearing the court will consider anything you and the person who is bound by this order want to say before deciding whether to make a final restraining order. The court will let you know if a final order

hearing is to be held and where and when you need to attend. Even if the person who is bound by this
order does object, this interim order will remain in force until the final order hearing.

If the person who is bound by this order does not object this order will automatically become a final order which remains in force for the period specified in the order or —

(a)

if no period is specified and the person is not a child, for 2 years from the date on which this order was served on the person; or

(b)

if no period is specified and the person is a child, for 6 months from the date on which this order was served on the person.

If the person was in prison at the time the court received the person’s “Consent” form, the order will stay

in force while the person is in prison and will expire 2 years after the date on which the person is released breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

from prison (or longer if specified in the order).
You will then not need to attend a final order hearing.
Counselling, support and/or legal services may be of assistance to you.

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If the order is a final order

A final family violence restraining order has been made to protect you on the terms set out on the front of this order.

This order will come into force when it is served on the person who is bound by this order, or at a later time, if this is specified on the front of this order, and it will remain in force until it expires or is varied or cancelled by a court. The person who is bound by this order must comply with this order at all times while it is in force.

If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if it was made at a final order hearing and —
(a) the person is not a child, 2 years after this final order comes into force; or
(b) the person is a child, 6 months after this final order comes into force;

or

if it was a telephone order which became a final order because the person did not object, 3 months, or any shorter period specified in the order, after the telephone order was served on the person.

If the person was in prison at the time this order was made, the order expires —

in the case of an order made at a final order hearing or an interim order which became the final order, 2 years after the date on which the person is released from prison (or longer if specified in the order);
in the case of a telephone order which became the final order because the person did not object, 3 months after the date on which the person is released from prison (or shorter if specified in the order).

If, in the future, you want the order varied or cancelled you may apply to the court. The person who is bound by this order may also apply to have the order varied or cancelled. If you would like more information about doing this you should consult your lawyer or the registrar of the court.

Penalty: It is an offence to breach a family violence restraining order. If the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

Additional information about breaching the order

Note 1:  If the person bound by this order breaches it and you aid the person in that breach, you will not
commit an offence however the court might decide to vary or cancel the order (see the
Restraining Orders Act 1997 section 61B(3) and (4)).

Note 2: 

If the person who is bound by this order is convicted of breaching the order and the person has been convicted of at least 2 other offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years before the conviction for breaching this order, the person will face a penalty that is or includes imprisonment (or, if the person is a child, detention) unless the court decides under section 61A(6) of the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person bound by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS

BOUND BY THE ORDER WAS PRESENT IN COURT WHEN IT WAS MADE

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Form 2 Family violence restraining order

Part E Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving order:
serving
I am  the registrar of the court
order  a police officer Rank, number and station: ___________________
 a prison officer Prison: ___________________________________

 a person authorised by the registrar Date of authorisation: _________

Service Method of service:  personal  oral  by post  substituted service

Place where order served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person who
is bound by
the order] Signature: …………………………………...................

(If possible to obtain)

Certificate I certify that on the day and at the time and place set out above —

 I personally served this order on the person who is bound by the order

 I orally served this order on the person who is bound by this order

 I posted this order to the person who is bound by this order

 I took the steps directed by the court to effect substituted service of this

order on the person who is bound by this order in accordance with the

Restraining Orders Act 1997 Part 6 Division 2.

In the case of oral service, I also certify that I —

gave the person who is bound by this order the information required by the Restraining Orders Act 1997 section 55(5) and that the person appeared to understand what was said; or
arranged for someone else over the age of 16 years to give the information to the person in accordance with the Restraining Orders Act 1997 section 55(5A).
Signature:  Date:
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Form 2 Family violence restraining order

Part F Details of family order

Restraining Orders Act 1997 s. 66 Number:
Details of family order Jurisdiction:
Annexure to application Location:
Parties to Name:
the family Address: street:
order or suburb: postcode:
proceedings Name:
Address: street:
suburb:  postcode:
Children Names:
1.
2.
3.
4.
Address: street:
suburb:  postcode:
Current Date order was made: Family Court matter no.:
family order Court by which order was made:
Terms of family order which relate to the respondent’s rights in relation
to children:

[If the person seeking to be protected by the restraining order is a party to the family order, attach a copy of the family order. If not, fill in the details as far as you (or the person seeking to be protected) are aware of them.]

Current
Court:  Family Court matter no.:
proceedings  Terms of family order being sought which relate to the respondent’s rights in
for family  relation to children:
order 
Are these terms of the order being opposed?  Yes  No  Unknown
Applicant 
Signature:  Date:
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Form 3 Conduct agreement order Part A Conduct agreement order

Restraining Orders Act 1997 Number:
s. 10H and 43 Jurisdiction:
Conduct agreement order Location:
Person who Family name: Date of birth:
has agreed Other names:
to be bound Home street:
by this order address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
protected Other names:
Type of This a final order.
order
Terms of
this order
Information In addition to the terms of this order, the court informs you that the following
about behaviour and activities are unlawful:

unlawful behaviour and

activities
Order made
Date order made:  Time order made:
Registrar  Date:
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Form 3 Conduct agreement order

Part B Information to be on the copy of order given to the

person who is bound by the order

IMPORTANT INFORMATION

FOR PERSON BOUND BY THIS ORDER

Terms of conduct agreement order

Although you do not admit that you have committed family violence, you have agreed to be bound by a
conduct agreement order on the terms set out on the front of this order.
This order came into force when it was served on you, or at a later time, if this is specified on the front of
this order, and it will remain in force until it expires or is varied or cancelled by a court. You must comply
with this order at all times while it is in force.
If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if you are not a child, 2 years after this order comes into force; or
if you are a child, 6 months after this order comes into force.

If you were in prison at the time this order was made, the order will stay in force while you are in prison and will expire 2 years after the date on which you are released from prison (or longer if specified in the order).

If, in the future, you want the order varied or cancelled you may apply to the court. If you would like more
information about doing this you should consult your lawyer or the registrar of the court.
Penalty: It is an offence to breach a conduct agreement order. If you breach this order you may be arrested
and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

Additional information about conviction for breaching the order

Note 1:  If you are convicted of breaching this order, the fact that the person protected by the order aided
you in the breach is not a mitigating factor for the purposes of your sentencing (see the
Restraining Orders Act 1997 section 61B(2)).
Note 2:  If you are convicted of breaching this order and you have been convicted of at least 2 other
offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years
before your conviction for breaching this order, you will face a penalty that is or includes
imprisonment (or, if you are a child, detention) unless the court decides under section 61A(6) of
the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person protected by this order, request a copy of any affidavit received in evidence in relation
to this order the registrar of the court where the application for the order was made is to provide a copy of the

affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF YOU WERE
PRESENT IN COURT WHEN IT WAS MADE

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Form 3 Conduct agreement order

Part C Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON PROTECTED BY THIS ORDER

Terms of conduct agreement order

Although the respondent does not admit to having committed family violence, the respondent has agreed
to be bound by a conduct agreement order on the terms set out on the front of this order.
This order will come into force when it is served on the person who is bound by this order, or at a later
time, if this is specified on the front of this order, and it will remain in force until it expires or is varied or
cancelled by a court. The person who is bound by this order must comply with this order at all times while
it is in force.
If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if the person bound by this order is not a child, 2 years after this order comes into force; or
if the person bound by this order is a child, 6 months after this order comes into force.

If the person bound by this order was in prison at the time this order was made, the order will stay in force
while the person is in prison and will expire 2 years after the date on which the person is released from
prison (or longer if specified in the order).
If, in the future, you want the order varied or cancelled you may apply to the court. The person who is
bound by this order may also apply to have the order varied or cancelled. If you would like more
information about doing this you should consult your lawyer or the registrar of the court.
Penalty: It is an offence to breach a conduct agreement order. If the person who is bound by this order
breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or
imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

Additional information about breaching the order

Note 1:  If the person bound by this order breaches it and you aid the person in that breach, you will not
commit an offence however the court might decide to vary or cancel the order (see the
Restraining Orders Act 1997 section 61B(3) and (4)).

Note 2: 

If the person who is bound by this order is convicted of breaching the order and the person has been convicted of at least 2 other offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years before the conviction for breaching this order, the person will face a penalty that is or includes imprisonment (or, if the person is a child, detention) unless the court decides under section 61A(6) of the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person bound by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS

BOUND BY THE ORDER WAS PRESENT IN COURT WHEN IT WAS MADE

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Form 3 Conduct agreement order

Part D Information to be on the proof of service copy

Certificate of service

Conduct agreement order no.:

Court of issue:

Person Name of person serving order:
serving I am:
order  the registrar of the court
 a police officer Rank, number and station: ___________________
 a prison officer Prison: __________________________________
 a person authorised by the registrar Date of authorisation: _________
Service Method of service:  personal  oral  by post  substituted service

Place where order served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person who
is bound by
the order] Signature: …………………………………...................

(If possible to obtain)

Certificate I certify that on the day and at the time and place set out above —

 I personally served this order on the person who is bound by the order

 I orally served this order on the person who is bound by this order

 I posted this order to the person who is bound by this order

 I took the steps directed by the court to effect substituted service of this

order on the person who is bound by this order in accordance with the

Restraining Orders Act 1997 Part 6 Division 2.

In the case of oral service, I also certify that I —

gave the person who is bound by this order the information required by the Restraining Orders Act 1997 section 55(5) and that the person appeared to understand what was said; or
arranged for someone else over the age of 16 to give the information to the person in accordance with the Restraining Orders Act 1997 section 55(5A).
Signature:  Date:
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Form 3 Conduct agreement order

Part E Details of family order

Restraining Orders Act 1997 s. 66 Number:
Details of family order Jurisdiction:
Annexure to application Location:
Parties to Name:
the family Address: street:
order or suburb: postcode:
proceedings Name:
Address: street:
suburb:  postcode:
Children Names:
1.
2.
3.
4.
Address: street:
suburb:  postcode:
Current Date order was made: Family Court matter no.:
family order Court by which order was made:
Terms of family order which relate to the respondent’s rights in relation to children:

[If the person seeking to be protected by the conduct agreement order is a party to the family order, attach a copy of the family order. If not, fill in the details as far as you (or the person seeking to be protected) are aware of them.]

Current
Court:  Family Court matter no.:
proceedings  Terms of family order being sought which relate to the respondent’s rights in
for family  relation to children:
order 
Are these terms of the order being opposed?  Yes  No  Unknown
Applicant 
Signature:  Date:
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Form 4 Section 63A family violence restraining order Part A Section 63A family violence restraining order

Restraining Orders Act 1997 s. 63A Number:
Section 63A family violence Jurisdiction:
restraining order Location:
Person Family name: Date of birth:
who is Other names:
bound by Home street:
this order address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
protected Other names:
Lifelong This order remains in force for the period of the life of the person who is
order bound by this order.

Terms of this order

Order
Date order made:  Time order made:
made 
Registrar 
Date:
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Form 4 Section 63A family violence restraining order

Part B Information to be on the copy of the order given to the

person who is bound by the order IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

Section 63A family violence restraining order

A family violence restraining order has been made against you under the Restraining
Orders Act 1997 section 63A. The order is in the terms set out on the front of this
order. This order came into force when it was served on you, or at a later time, if this
is specified on the front of this order. You must comply with this order for the rest of
your life.
Penalty: It is an offence to breach a family violence restraining order. If you breach
this order you may be arrested and on conviction will face a penalty of up to $6 000
or imprisonment for 2 years, or both. If you breach the order in the presence of a child

with whom you are in a family relationship (e.g. your child, your partner’s child or a

child who ordinarily resides with you) the court sentencing you will consider this an

aggravating factor.

Note 1:  If you are convicted of breaching this order, the fact that the person
protected by the order aided you in the breach is not a mitigating factor for
the purposes of your sentencing (see the Restraining Orders Act 1997
section 61B(2)).
Note 2:  If you are convicted of breaching this order and you have been convicted of
at least 2 other offences under the Restraining Orders Act 1997 section 61(1)
or (2a) within the period of 2 years before your conviction for breaching this
order, you will face a penalty that is or includes imprisonment (or, if you are
a child, detention) unless the court decides under section 61A(6) of the Act
not to impose such a penalty.

Counselling, support and/or legal services may be of assistance to you.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS BOUND BY THE ORDER WAS PRESENT IN

COURT WHEN IT WAS MADE

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Form 4 Section 63A family violence restraining order

Part C Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON WHO IS PROTECTED BY THIS ORDER

Section 63A family violence restraining order

A family violence restraining order has been made to protect you under the Restraining Orders Act 1997 section 63A. The order is in the terms set out on the front of this order. This order came into force when it was served on the person who is bound by the order, or at a later time if this is specified on the front of this order. The person who is bound by this order must comply with this order for the rest of the person’s life.

Penalty: It is an offence to breach a family violence restraining order. If the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both. Note 1: If the person bound by this order breaches it and you aid the person in that

breach, you will not commit an offence however the court might decide to
vary or cancel the order (see the Restraining Orders Act 1997

section 61B(3) and (4)).

Note 2:  If the person who is bound by this order is convicted of breaching this order
and the person has been convicted of at least 2 other offences under the
Restraining Orders Act 1997 section 61(1) or (2a) within the period of
2 years before the conviction for breaching this order, the person will face a
penalty that is or includes imprisonment (or, if the person is a child,
detention) unless the court decides under section 61A(6) of the Act not to
impose such a penalty.

Counselling, support and/or legal services may be of assistance to you.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS BOUND BY THE ORDER WAS PRESENT IN

COURT WHEN IT WAS MADE

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Form 5 Application for violence restraining order

Number:

Restraining Orders Act 1997 s. 25

Violence restraining order Jurisdiction:
Location:

Application

Applicant Family name: Date of birth:
[If not the Other names:
person seeking
to be protected] Address: street:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Person Family name: Date of birth:
seeking to be Other names:
protected Address: street:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Respondent Family name: Date of birth:
[Fill in as many Other names:
details as you Home street:
can] address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Grounds for Give details of the respondent’s behaviour.
application
Firearms
Does the respondent have a firearm or firearms licence?  Yes  No  Unknown
Does the respondent have access to a firearm at work?  Yes  No  Unknown
First hearing
Do you want the respondent to be present at the first hearing?  Yes  No
Applicant
Signature:  Date:
[Not essential if
applicant is a
police officer]
Hearing 
Court:  Date: Time:
[To be filled in 
by the court

Signature of registrar:

Notification  I certify that on __ __/__ __/__ __ at _______ am/pm at _______________________________
[To be filled in  I notified the applicant of the hearing date.
by the court

Signature of registrar:

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Form 6 Violence restraining order Part A Violence restraining order

Restraining Orders Act 1997 Number:
s. 29, 32, 43, 49 and 63 Jurisdiction:
Location:

Violence restraining order

Person who Family name: Date of birth:
is bound by Other names:
this order Home street:
address: suburb:  postcode:
Work  street:
address: suburb:  postcode:
Phone nos.:  work: home: mobile:
Applicant Family name: Date of birth:
for the order
[If not the Other names:
person to be
protected]
Person Family name: Date of birth:
protected Other names:
Type of The order is  for 72 hours or less  an interim order  a final order
order

Terms of this order

Information In addition to the terms of this order, the court informs you that the following
about behaviour and activities are unlawful —

unlawful behaviour and

activities
Order made
Date order made:  Time order made:
Registrar  Date:
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Form 6 Violence restraining order

Part B Information to be on the copy of order given to the

person who is bound by the order IMPORTANT INFORMATION

FOR PERSON BOUND BY THIS ORDER

If the order is for 72 hours or less

A violence restraining order has been made against you for 72 hours or less on the terms set out on the arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both. If you breach the order in the presence of a child with whom you are in a family relationship (e.g. your child, your partner’s child or a child who ordinarily resides with you) the court sentencing you will consider this
front of this order. This order came into force when it was served on you, or at a later time, if this is
specified on the front of this order. You must comply with this order until the end of the period specified
in the order.

an aggravating factor.

Counselling, support and/or legal services may be of assistance to you.

If the order is an interim order

An interim violence restraining order has been made against you on the terms set out on the front of this order. This order came into force when it was served on you, or at a later time, if this is specified on the front of this order, and it will remain in force until a final order is made or a court decides not to make a final order. You must comply with this order at all times while it is in force.

You have an opportunity to object to the order before it becomes a final order. of the other copy of this order and return it to the court within 21 days from the date this order was served on you. You will then not need to attend a final order hearing and the order will automatically become a final order which remains in force for the period specified in the order or —

If you want to object to this order being made final you must fill in the “Objection” section on the back
of the other copy of this order and return it to the court within 21 days from the date this order was served
on you. The court will then arrange a final order hearing at which it will consider anything you want to say
before deciding whether to make a final violence restraining order. The court will let you know where and
when the final order hearing will be held.

(a)

if no period is specified and you are not a child, for 2 years from the date this interim order was served on you; or

(b)

if no period is specified and you are a child, for 6 months from the date this interim order was served on you.

If you do nothing

and do not fill in and return the other copy of this order within 21 days the court will arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

assume that you do not object and the interim order will automatically become a final order.
Counselling, support and/or legal services may be of assistance to you.

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If the order is a final order

A final violence restraining order has been made against you on the terms set out on the front of this order. This order came into force when it was served on you, or at a later time, if this is specified on the front of this order, and it will remain in force until it expires or is varied or cancelled by a court. You must comply with this order at all times while it is in force.

If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if it was made at a final order hearing and —
(a) you are not a child, 2 years after this final order comes into force; or
(b) you are a child, 6 months after this final order comes into force;

or

if it was a telephone order which became a final order because you did not object, 3 months, or any shorter period specified in the order, after the telephone order was served on you.

If, in the future, you want the order varied or cancelled you may apply to the court. If you would like more arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

information about doing this you should consult your lawyer or the registrar of the court.

Counselling, support and/or legal services may be of assistance to you.

Additional information about conviction for breaching the order

Note 1:  If you are convicted of breaching this order, the fact that the person protected by the order aided
you in the breach is not a mitigating factor for the purposes of your sentencing (see the
Restraining Orders Act 1997 section 61B(2)).
Note 2:  If you are convicted of breaching this order and you have been convicted of at least 2 other
offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years
before your conviction for breaching this order, you will face a penalty that is or includes
imprisonment (or, if you are a child, detention) unless the court decides under section 61A(6) of
the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person protected by this order, request a copy of any affidavit received in evidence in relation
to this order the registrar of the court where the application for the order was made is to provide a copy of the

affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF YOU WERE

PRESENT IN COURT WHEN IT WAS MADE

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Form 6 Violence restraining order

Part C Information to be on the respondent’s endorsed copy of

the order

IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

For interim orders only

If you want to object to this order being made final you must fill in the

“Objection” section below and return it to the court within 21 days from the date this

order was served on you. The court will then arrange a final order hearing at which it
will consider anything you want to say before deciding whether to make a final
violence restraining order. The court will let you know where and when the final
order hearing will be held.

If you do not object to this order being made final you must fill in the “Consent” section below and return this copy of the order to the court within 21 days of the date it was served on you.

If you do nothing and do not fill in and return this copy of the order to the

court within 21 days, this interim order will automatically become a final order.

Objection

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:
Will you be represented by a lawyer at the final order hearing?  Yes  No
If yes: lawyer’s name: 

lawyer’s firm:

How many witnesses (including yourself) do you intend to call? _________________

Does this interim order prevent you from —

going to where you normally live?  Yes  No
going to where you work or otherwise prevent
you from doing your job?  Yes  No
being in possession of a firearm which is
essential for your job?  Yes  No
Signature:  Date:

OR

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Consent

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:

I do not object to a final order being made on the same terms as this interim order. will automatically become a final order which will stay in force for the period specified in the order or —

(a)

if no period is specified and I am not a child, for 2 years from the date on which this interim order was served on me; or

(b)

if no period is specified and I am a child, for 6 months from the date on which this interim order was served on me.

Signature:  Date:
20 June 2017 GOVERNMENT GAZETTE, WA 3019

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Form 6 Violence restraining order

Part D Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON PROTECTED BY THIS ORDER

If the order is for 72 hours or less

A violence restraining order has been made to protect you for 72 hours or less on the terms set order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

out on the front of this order. This order will come into force when it is served on the person
who is bound by this order, or at a later time, if this is specified on the front of this order. The
person who is bound by this order must comply with this order until the end of the period
specified in the order.

Counselling, support and/or legal services may be of assistance to you.

If the order is an interim order

An interim violence restraining order has been made to protect you on the terms set out on the become a final order which remains in force for the period specified in the order or —
front of this order. This order will come into force when it is served on the person bound by
this order, or at a later time, if this is specified on the front of this order, and it will remain in
force until a final order is made or a court decides not to make a final order. The person who is
bound by this order must comply with this order at all times while it is in force. The person
who is bound by this order has 21 days within which to object to the order before it becomes a
final order.
If the person who is bound by this order does object you will need to attend a final order
hearing. At that hearing the court will consider anything you and the person who is bound by
this order want to say before deciding whether to make a final restraining order. The court will
let you know if a final order hearing is to be held and where and when you need to attend.
Even if the person who is bound by this order does object, this interim order will remain in
force until the final order hearing.

(a) if no period is specified and the person bound by the order is not a child, for 2 years from the date this interim order was served on the person bound by this order. You will then not need to attend a final order hearing; or
(b) if no period is specified and the person bound by the order is a child, for 6 months from the date this interim order was served on the person bound by this order. You will then not need to attend a final order hearing.

Penalty: It is an offence to breach a violence restraining order. If the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

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If the order is a final order

A final violence restraining order has been made to protect you on the terms set out on the
front of this order.
This order will come into force when it is served on the person who is bound by this order, or
at a later time, if this is specified on the front of this order, and it will remain in force until it
expires or is varied or cancelled by a court. The person who is bound by this order must
comply with this order at all times while it is in force.
If there is a duration specified in the order, the order expires at the end of the specified period.

If there is no duration specified in the order, the order expires —

if it was made at a final order hearing and —
(a) you are not a child, 2 years after this final order comes into force; or
(b) you are a child, 6 months after this final order comes into force;

or

if it was a telephone order which became a final order because the person who is bound by the order did not object, 3 months (or any shorter time specified in the order) after the telephone order was served on the person who is bound by the order.

If, in the future, you want the order varied or cancelled you may apply to the court. The person who is bound by this order may also apply to have the order varied or cancelled. If you would like more information about doing this you should consult your lawyer or the registrar of the court.

Penalty: It is an offence to breach a violence restraining order. If the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling, support and/or legal services may be of assistance to you.

Additional information about breaching the order
Note 1: If the person bound by this order breaches it and you aid the person in that breach,

you will not commit an offence however the court might decide to vary or cancel the
order (see the Restraining Orders Act 1997 section 61B(3) and (4)).

Note 2: If the person who is bound by this order is convicted of breaching the order and the person has been convicted of at least 2 other offences under the Restraining Orders Act 1997 section 61(1) or (2a) within the period of 2 years before the conviction for breaching this order, the person will face a penalty that is or includes imprisonment (or, if the person is a child, detention) unless the court decides under section 61A(6) of the Act not to impose such a penalty.

Affidavit evidence may be provided on request

If you, or the person bound by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS

BOUND BY THE ORDER WAS PRESENT IN COURT WHEN IT WAS MADE

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Form 6 Violence restraining order

Part E Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving order:
serving I am:
order  the registrar of the court
 a police officer Rank, number and station: ___________________
 a prison officer Prison: ___________________________________
 a person authorised by the registrar Date of authorisation: _________
Service Method of service:  personal  oral  by post  substituted service

Place where order served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person who
is bound by Signature: …………………………………...................
the order] (If possible to obtain)
Certificate I certify that on the day and at the time and place set out above:

 I personally served this order on the person who is bound by the order

 I orally served this order on the person who is bound by this order

 I posted this order to the person who is bound by this order

 I took the steps directed by the court to effect substituted service of this

order on the person who is bound by this order in accordance with the

Restraining Orders Act 1997 Part 6 Division 2.

In the case of oral service, I also certify that I —

gave the person who is bound by this order the information required by the Restraining Orders Act 1997 section 55(5) and that the person appeared to understand what was said; or
arranged for someone else over the age of 16 years to give the information to the person in accordance with the Restraining Orders Act 1997 section 55(5A).
Signature:  Date:
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Form 7 Section 63A violence restraining order Part A Section 63A violence restraining order

Restraining Orders Act 1997 s. 63A Number:
Section 63A violence Jurisdiction:
restraining order Location:
Person who Family name: Date of birth:
is bound by Other names:
this order
Home street:
address: suburb:  postcode:
Work  street:
address: suburb:  postcode:
Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
protected Other names:
Lifelong This order remains in force for the period of the life of the person who is bound by
order this order.

Terms of this order

Order made
Date order made:  Time order made:
Registrar  Date:
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Form 7 Section 63A violence restraining order

Part B Information to be on the copy of the order given to the

person who is bound by the order IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

Section 63A violence restraining order

A violence restraining order has been made against you under the Restraining Orders Act 1997 section 63A. The order is in the terms set out on the front of this order. This order came into force when it was served on you, or at a later time, if this is specified on the front of this order. You must comply with this order for the rest of your life.

Penalty: It is an offence to breach a violence restraining order. If you breach this order you may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both. If you breach the order in the presence of a child with whom you are in a family relationship (e.g. your child, your partner’s child or a
child who ordinarily resides with you) the court sentencing you will consider this an

aggravating factor.

Note 1:  If you are convicted of breaching this order, the fact that the person
protected by the order aided you in the breach is not a mitigating factor for
the purposes of your sentencing (see the Restraining Orders Act 1997
section 61B(2)).
Note 2:  If you are convicted of breaching this order and you have been convicted of
at least 2 other offences under the Restraining Orders Act 1997 section 61(1)
or (2a) within the period of 2 years before your conviction for breaching this
order, you will face a penalty that is or includes imprisonment (or, if you are
a child, detention) unless the court decides under section 61A(6) of the Act
not to impose such a penalty.

Counselling, support and/or legal services may be of assistance to you.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF YOU WERE

PRESENT IN COURT WHEN IT WAS MADE

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Form 7 Section 63A violence restraining order

Part C Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON WHO IS PROTECTED BY THIS ORDER

Section 63A violence restraining order

A violence restraining order has been made to protect you under the Restraining Orders Act 1997 section 63A. The order is in the terms set out on the front of this order. This order came into force when it was served on the person who is bound by

the order, or at a later time, if this is specified on the front of this order. The person who is bound by this order must comply with this order for the rest of the person’s life.
Penalty: It is an offence to breach a violence restraining order. If the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Note 1: 

If the person bound by this order breaches it and you aid the person in that breach, you will not commit an offence however the court might decide to vary or cancel the order (see the Restraining Orders Act 1997

section 61B(3) and (4)).
Note 2:  If the person who is bound by this order is convicted of breaching this order
and the person has been convicted of at least 2 other offences under the
Restraining Orders Act 1997 section 61(1) or (2a) within the period of
2 years before the conviction for breaching this order, the person will face a
penalty that is or includes imprisonment (or, if the person is a child,
detention) unless the court decides under section 61A(6) of the Act not to
impose such a penalty.

Counselling, support and/or legal services may be of assistance to you.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS BOUND BY THE ORDER WAS PRESENT IN

COURT WHEN IT WAS MADE

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Form 8 Application for misconduct restraining order

Restraining Orders Act 1997 s. 38(2) Number:
Misconduct restraining order Jurisdiction:
Application Location:
Applicant Family name: Date of birth:
[If not the Other names:
person
seeking to be Address: street:
suburb:  postcode:

protected]

Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
seeking to Other names:
be protected Address: street:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Respondent Family name: Date of birth:
[Fill in as Other names:
many Home street:
details as you address:
suburb:  postcode:
can
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Grounds for Give details of the respondent’s behaviour.

application

Firearms

Does the respondent have a firearm or firearms licence?  Yes  No  Unknown Does the respondent have access to a firearm at work?  Yes  No  Unknown

Applicant
Signature:  Date:
Hearing 
Court:  Date: Time:
[To be filled 
in by the 
court Registrar:
Notification  I certify that on __ __/__ __/__ __ at _______ am/pm at _______________________
[To be filled  I notified the applicant of the hearing date.
in by 
the court Registrar:
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Form 9 Misconduct restraining order Part A Misconduct restraining order

Restraining Orders Act 1997 Number:
s. 43, 49 and 63 Jurisdiction:
Misconduct restraining order Location:
Person who Family name: Date of birth:
is bound by Other names:
this order Home street:
address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Applicant Family name: Date of birth:
for order
[If not the Other names:
person to be
protected]
Person Family name: Date of birth:
protected Other names:
Terms of the
order
Order made Date order made: Time order made:
Registrar Date:
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Form 9 Misconduct restraining order

Part B Information to be on the copy of the order given to the

person who is bound by the order IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

Misconduct Restraining Order

A misconduct restraining order has been made against you on the terms set out on the front of this order. This order comes into force when it was served on you, or at a later time, if this is specified on the front of this order, and it will remain in force until it expires or is varied or
cancelled by a court. You must comply with this order at all times while it is in force.
If there is a duration specified in the order, the order expires at the end of the specified period.
If there is no duration specified in the order, the order expires 12 months after it comes into
force.
If, in the future, you want the order varied or cancelled you may apply to the court. If you would
like more information about doing this you should consult your lawyer or the registrar of the
court.
Penalty: It is an offence to breach a misconduct restraining order. If you breach this order you
may be arrested and on conviction will face a penalty of up to $1 000.
Note: If you are convicted of breaching this order, the fact that the person protected by the order
aided you in the breach is not a mitigating factor for the purposes of your sentencing (see the
Restraining Orders Act 1997 section 61B(2)).

Counselling, support and/or legal services may be of assistance to you.

Affidavit evidence may be provided on request

If you, or the person protected by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF YOU WERE
PRESENT IN COURT WHEN IT WAS MADE

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Form 9 Misconduct restraining order

Part C Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR THE PERSON PROTECTED BY THE ORDER

Misconduct Restraining Order

A misconduct restraining order has been made to protect you on the terms set out on the front of this order. This order comes into force when it is served on the person who is bound by this order, or at a later time, if this is specified on the front of this order, and it will remain in force until it expires or is varied or cancelled by a court. The person who is bound by this order must comply with this order at all times while it is in force.

If there is a duration specified in the order, the order expires at the end of the specified period.
If there is no duration specified in the order, the order expires 12 months after it comes into
force.
If, in the future, you want the order varied or cancelled you may apply to the court. The person
who is bound by this order may also apply to have the order varied or cancelled. If you would
like more information about doing this you should consult your lawyer or the registrar of the
court.
Penalty: It is an offence to breach a misconduct restraining order. If the person bound by this
order breaches this order the person may be arrested and on conviction will face a penalty of up
to $1 000.
Note: If the person bound by this order breaches it and you aid the person in that breach, you
will not commit an offence however the court might decide to vary or cancel the order (see the

Restraining Orders Act 1997 section 61B(3) and (4)).

Counselling, support and/or legal services may be of assistance to you.

Affidavit evidence may be provided on request

If you, or the person bound by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

THIS ORDER COMES INTO FORCE IMMEDIATELY IF THE PERSON WHO IS

BOUND BY THE ORDER WAS PRESENT IN COURT WHEN IT WAS MADE

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Form 9 Misconduct restraining order

Part D Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving order:
serving I am:
order  the registrar of the court
 a police officer Rank, number and station: ___________________
 a prison officer Prison: ___________________________________
 a person authorised by the registrar Date of authorisation: _________
Service Method of service:  personal  oral  by post  substituted service

Place where order served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person who
is bound by
the order] Signature: …………………………………...................

(If possible to obtain)

Certificate I certify that on the day and at the time and place set out above:

 I personally served this order on the person who is bound by the order

 I orally served this order on the person who is bound by this order

 I posted this order to the person who is bound by this order

 I took the steps directed by the court to effect substituted service of this

order on the person who is bound by this order in accordance with the

Restraining Orders Act 1997 Part 6 Division 2.

In the case of oral service, I also certify that I —

gave the person who is bound by this order the information required by the Restraining Orders Act 1997 section 55(5) and that the person appeared to understand what was said; or
arranged for someone else over the age of 16 years to give the information to the person in accordance with the Restraining Orders Act 1997 section 55(5A).
Signature:  Date:
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Form 10 Telephone order

Part A Court copy of telephone order

Restraining Orders Act 1997 s. 23 Number:
Telephone family violence Jurisdiction:
restraining order / Violence Location:

restraining order

Person who is Family name: Date of birth:
bound by this Other names:
order Home street:
address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Protected Family name: Date of birth:
person Other names:
Type of order The order is  a Family Violence Restraining Order
 a Violence Restraining Order
 for 72 hours or less
 an interim order
Terms of the
order
Order made Date order made: Time order made:
Authorised Name:
person Rank and number/identification:
Signature:  Date:
Confirmation This order  is correct  is not correct and is to be amended as shown
by Magistrate above
Signature:  Date:
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Form 10 Telephone order

Part B Copy of the order given to the person who is bound by

the order

Restraining Orders Act 1997 s. 23 Number:
Telephone family violence Jurisdiction:
restraining order / Violence Location:

restraining order

Person who Family name: Date of birth:
is bound by Other names:
this order Home street:
address:
suburb:  postcode:
Work street:
address:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
protected Other names:
Type of The order is  a Family Violence Restraining Order
order  a Violence Restraining Order
 for 72 hours or less
 an interim order
Terms of the
order
Order made Date order made: Time order made:
Authorised Name:
person Rank and number/identification:
Signature:  Date:
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Form 10 Telephone order

Part C Information to be on the copy of the order to be given to

the person who is bound by the order

IMPORTANT INFORMATION

FOR PERSON WHO IS BOUND BY THIS ORDER

If the order is for 72 hours or less

A family violence restraining order / violence restraining order has been made against you for 72 hours or less on the terms set out on the front of this order. This order came into force when it was served on you, or at a later time, if this is specified on the front of this order. You must comply with this order until the end of the period specified in the order.

Penalty: It is an offence to breach a family violence restraining order / violence restraining order. If you breach this order you may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both. If you breach the order in the presence of a child with whom you are in a family relationship (e.g. your child, your partner’s child or a child who ordinarily resides with you) the

court sentencing you will consider this an aggravating factor.

Counselling, support and/or legal services may be of assistance to you.

If the order is an interim order

An interim family violence restraining order / violence restraining order has been made against you on the terms set out on the front of this order. This order came into force when it was served on you, or at a later time, if this is specified on the front of this order, and it will remain in force until a final order is made or a court decides not to make a final order. You must comply with this order at all times while it is in force.

If you object to this order being made final
you must fill in the “Objection” section on the back of the of the other copy of this order and return it to the court within 21 days from the date this order was served on you. You will then not need to attend a final order hearing and the order will automatically become a final order which will stay in force for the period specified in the order or —
other copy of this order and return it to the court within 21 days from the date this order was served on
you. The court will then arrange a final order hearing at which it will consider anything you want to say
before deciding whether to make a final family violence restraining order / violence restraining order. The
court will let you know where and when the final order hearing will be held.

(a) if no period is specified and you are not a child, for 2 years from the date on which this order was served on you; or
(b) if no period is specified and you are a child, for 6 months from the date on which this order was served on you.

If the order is a family violence restraining order and you were in prison at the time the court received your “Consent” form, the order will stay in force while you are in prison and for a further 3 months from

the date on which you are released from prison (or shorter if specified in the order). arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

If you do nothing and do not fill in and return the other copy of this order within 21 days the court will
assume that you do not object and the interim order will automatically become a final order.
Counselling, support and/or legal services may be of assistance to you.

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Additional information about conviction for breaching the order

If you are convicted of breaching this order, the fact that the person protected by the order aided you in the breach is not a mitigating factor for the purposes of your sentencing (see the Restraining Orders Act 1997 section 61B(2)).

Affidavit evidence may be provided on request

If you, or the person protected by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

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Form 10 Telephone order

Part D — Information to be on the respondent’s endorsed copy

IMPORTANT INFORMATION

FOR THE PERSON WHO IS BOUND BY THIS ORDER

For interim orders only

If you object to this interim order being made final you must fill in the

“Objection” section below and return this copy of the order to the court within

21 days of the date it was served on you.

If you do not object to this order being made final you must fill in the “Consent” section below and return this copy of the order to the court within 21 days of the date it was served on you.

If you do nothing and do not fill in and return this copy of the order to the court within 21 days this interim order will automatically become a final order.

Objection

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:
Will you be represented by a lawyer at the final order hearing?  Yes  No
If yes:  lawyer’s name:
lawyer’s firm:

How many witnesses (including yourself) do you intend to call? _________________

Does this interim order prevent you from —

going to where you normally live?  Yes  No
having contact with your children?  Yes  No
going to where you work or otherwise prevent
you from doing your job?  Yes  No
being in possession of a firearm which is
essential for your job?  Yes  No
Signature:  Date:

OR

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Consent

Order Restraining order no.: Court of issue:
Family name:  Date of birth:
Other names: 
Address:  street:
suburb:  postcode:

I do not object to a final order being made on the same terms as this interim order. will automatically become a final order which will stay in force for —

(a) the period specified in the order; or
(b) if no period is specified and I am not a child, for 2 years from the date on which this order was served on me; or
(c) if no period is specified and I am a child, for 6 months from the date on which this order was served on me.

If the order is a family violence restraining order and I am in prison when the court receives this form, the order will stay in force while I am in prison and for a further 3 months from the date on which I am released from prison (or shorter if specified in the order).

Signature:  Date:
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Form 10 Telephone order

Part E Information to be on the copy of the order given to the

person protected by the order

IMPORTANT INFORMATION

FOR PERSON PROTECTED BY THIS ORDER

If the order is for 72 hours or less

A family violence restraining order / violence restraining order has been made to protect you for 72 hours or less on the terms set out on the front of this order. This order will come into force when it is served on the person who is bound by this order, or at a later time, if this is specified on the front of this order. The person who is bound by this order must comply with this order until the end of the period specified in the order.

Penalty: It is an offence to breach a family violence restraining order / violence restraining order. If the person bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

If the order is an interim order

An interim family violence restraining order / violence restraining order has been made to protect you on the terms set out on the front of this order. This order will come into force when it is served on the person bound by this order, or at a later time, if this is specified on the front of this order, and it will remain in

force until a final order is made or a court decides not to make a final order. The person who is bound by order which will stay in force for —
this order must comply with this order at all times while it is in force. The person who is bound by this
order has 21 days within which to object to the order before it becomes a final order.
If the person who is bound by this order does object you will need to attend a final order hearing. At
that hearing the court will consider anything you and the person who is bound by this order want to say
before deciding whether to make a final restraining order. The court will let you know if a final order
hearing is to be held and where and when you need to attend. Even if the person who is bound by this
order does object, this interim order will remain in force until the final order hearing.

(a) the period specified in the order; or
(b) if no period is specified and the person is not a child, for 2 years from the date on which this order was served on the person; or
(c) if no period is specified and the person is a child, for 6 months from the date on which this order was served on the person.

If the order is a family violence restraining order and the person was in prison at the time the Court received the person’s “Consent” form, the order will stay in force while the person is in prison and for a

further 3 months from the date on which the person is released from prison (or shorter if specified in the person who is bound by this order breaches this order the person may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

order).
You will then not need to attend a final order hearing.
Counselling, support and/or legal services may be of assistance to you.

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Additional information about breaching the order

If the person bound by this order breaches it and you aid the person in that breach, you will not commit an offence however the court might decide to vary or cancel the order (see the Restraining Orders Act 1997 section 61B(3) and (4)).

Affidavit evidence may be provided on request

If you, or the person bound by this order, request a copy of any affidavit received in evidence in relation to this order the registrar of the court where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

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Form 10 Telephone order

Part F Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving order:
serving I am:
order  the registrar of the court
 a police officer Rank, number and station: ___________________
 a prison officer Prison: ___________________________________
 a person authorised by the registrar Date of authorisation: _________
Service Method of service:  personal  oral  by post  substituted service

Place where order served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person who
is bound by
the order] Signature: …………………………………...................

(If possible to obtain)

Certificate I certify that on the day and at the time and place set out above —

 I personally served this order on the person who is bound by the order

 I orally served this order on the person who is bound by this order

 I posted this order to the person who is bound by this order

 I took the steps directed by the court to effect substituted service of this

order on the person who is bound by this order in accordance with the

Restraining Orders Act 1997 Part 6 Division 2.

In the case of oral service, I also certify that I —

gave the person who is bound by this order the information required by the Restraining Orders Act 1997 section 55(5) and that the person appeared to understand what was said; or
arranged for someone else over the age of 16 to give the information to the person in accordance with the Restraining Orders Act 1997 section 55(5A).
Signature:  Date:
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Form 11 Restraining order record of telephone application

Restraining Orders Act 1997 s. 21(4) Number:
Restraining order Jurisdiction:
Record of telephone Location:

application

Authorised Name:
person Rank and number/identification:
Contact phone no.:  Date of application:
Type of  Family violence restraining order
order sought  Violence restraining order
Reason for I  am  am not satisfied that the matter is sufficiently urgent to justify a
applying by telephone application.
telephone
Applicant The applicant is:
[If not the
person
 person seeking to be protected
 parent or guardian of a child who is seeking to be protected
seeking to be  a child welfare officer on behalf of a child who is seeking to be protected
protected]  authorised person

 legal guardian of the person who is seeking to be protected

Family name:  Date of birth:
Other names: 
Address: street: 
suburb:  postcode:
Phone nos.:  work: home: mobile:
Person Family name: Date of birth:
seeking to Other names:
be protected Address: street:
suburb:  postcode:
Phone nos.:  work: home: mobile:
Respondent Family name: Date of birth:
Other names:
Home street:
address: 
suburb:  postcode:
Work  street:
address: 
suburb:  postcode:
Phone nos.: work:  home: mobile:
The respondent  is  is not present
 is  is not being detained by a police officer
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Family Are there any current family orders relating to the respondent’s rights
orders in relation to children who may be affected by a restraining order?
 Yes  No  Unknown

Are there any current Family Court proceedings in which such orders are being sought?

 Yes  No  Unknown
Details of family order or proceedings
Firearms Does the respondent have a firearm or a firearms licence?
 Yes  No  Unknown
Does the respondent have access to a firearm at work?
 Yes  No  Unknown
Witnesses Applicant:
and
summary
of evidence Respondent:
Authorised person:
Other people:
Other notes
Decision
I  am  am not satisfied that a telephone order should be made.
and order The terms of the order are:

Magistrate Name:

Court where Magistrate is based:

Magistrate’s location when hearing application:

Signature:  Date: Time:
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Form 12 Application to vary or cancel a restraining order

Part A Application to vary or cancel a restraining order

Number:

Restraining Orders Act 1997 s. 45

Restraining order Jurisdiction:
Location:

Application to vary or cancel

Person Family name:
applying to Other names:
vary or cancel
Address:  street:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Are you: 

 the person protected by the order

the parent or guardian of a child protected by the order

 a police officer

the legal guardian of the person protected by the order

 the person bound by the order

Restraining Type of order:
order  Family Violence Restraining Order
 Violence Restraining Order
 Misconduct Restraining Order
Date order was made:  Restraining order no.:
Person who is bound by the order:
Person who is protected by the order:
Grounds for If you are the person bound by the restraining order, on what grounds do you seek leave to
leave to continue the application?
continue this
application
[Only fill this in
if the
application is
being made by
the person
bound by the
order]
Variation or Do you want the order to be cancelled and a replacement order to be made?  Yes

cancellation

[Please tick one Duration of order: An order made under this option will remain in force for a
box only.] period of 2 years from the date of service of the replacement order if no other
period is specified.
Do you want an additional order, to be read with the original order, which  Yes
states the variation?
Duration of order: Unless specified, an order made under this option will not vary
the duration of the original order.
Do you want the order to be cancelled without any further order being made?  Yes

Duration of order: An order cancelled under this option ceases to be in force at the conclusion of the hearing at which it is cancelled.

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Variation What are the specific changes you are seeking?
sought
Grounds for Why do you want the restraining order varied or cancelled?

variation or cancellation

If you are the Do you want this application to cancel the restraining order  Yes
person heard in the absence of the person bound by the order?
protected  No
Signature Signature of applicant:
Hearing Court: Date: Time:
Notification I certify that on __ __/__ __/__ __ at _____ am/pm at Signature of Registrar:
[To be filled in
by the court] ___________________________________________
I notified the person applying to vary or cancel the hearing
date.
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Form 12 Application to vary or cancel a restraining order

Part B Information to be on the copy of the application to be

given to the applicant

IMPORTANT INFORMATION

FOR THE APPLICANT

Application by the person protected by the restraining order

If you are the person protected by the restraining order (or someone acting on behalf of that person) and you have applied to vary or cancel the order, you must attend a hearing on the date set out on the front of this application. The court will summons the person who is bound by the order who should also attend. At that hearing the court will decide whether or not to vary or cancel the restraining order.

If you do not attend the hearing, your application may be dismissed.

Application by the person who is bound by the restraining order

If you are the person who is bound by the restraining order and you have applied to vary or cancel a restraining order, you must attend a hearing on the date set out on the front of this application. The person protected by the restraining order will not attend this hearing. At this
hearing you will have the opportunity to satisfy the court that you should be granted leave to


continue the application. To do this you will need to satisfy the court that one of the following

applies —

(a) you had a reasonable cause not to attend a prior hearing where the restraining order was made (this does not apply in respect of a hearing where you were not present because the person protected by the order chose to have the matter heard in your absence under the

Restraining Orders Act 1997 section 26);

(b) there is evidence to support a claim that a person protected by the order has persistently invited or encouraged you to breach the order, or by the person’s actions has persistently

attempted to cause you to breach the order;

(c)

there has been a substantial change in the relevant circumstances since the order was made;

(d)

if this application is made to vary or cancel an interim order, there is evidence to support a claim that the restraints imposed by the order are causing you unnecessary hardship.

If you do not may be dismissed

attend the hearing, your application . set a date for a further hearing and will summons the person protected by the order to attend. At that hearing the court will decide whether or not to vary or cancel the restraining order.

Your application to vary or cancel the restraining order will be dismissed if you do not satisfy
the court that one of the grounds set out above applies.
If you do not attend the hearing, your application may be dismissed.

Application to extend duration of order

If this application is to vary the restraining order by extending the duration of the order, then, copy of this application.

despite anything else in the Restraining Orders Act 1997, THE ORDER WILL NOT

3044 GOVERNMENT GAZETTE, WA 20 June 2017

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Form 13 Summons to vary or cancel restraining order

Part A Summons to vary or cancel restraining order

Number:

Restraining Orders Act 1997 s. 47

Restraining order Jurisdiction:
Location:

Summons to vary or cancel

An application has been made to vary or cancel the restraining order to which you (or a person of whom you are a parent or guardian) are a party. The details of the application are set out below. You are required to attend a court hearing on this matter at the place and time set out below.

Person Person protected by the order
summonsed Parent or guardian of a child protected by the order
Person bound by the order
Legal guardian of a person protected by the order
Child Welfare Officer on behalf of a child protected by the order
Family name:  Date of birth:
Other names: 
Home  street:
address: 
suburb:  postcode:
Work  street:
address: 
suburb:  postcode:
Phone nos.: work:  home: mobile:
Restraining Family Violence Restraining Order Date order made:
order  Violence Restraining Order Date order served:
Misconduct Restraining Order

Person bound by the order:

Person protected by the order:

Application An application has been made for the restraining order to be:
 cancelled
 varied
The variations sought to the order are as follows:
Grounds for
application
Hearing Court: Date: Time:
[To be filled in
by the court] Registrar:

If you do not attend the court hearing the restraining order may be varied or cancelled in your absence.

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Form 13 Summons to vary or cancel restraining order Part B Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving summons:
serving I am:
summons  the registrar of the court

 a police officer  a prison officer

Rank, number and station: ________________________

Prison: _______________________________________

a person authorised by the registrar Date of authorisation: _____________
Service Method of service:  personal  by post  substituted service

Place where summons served:

Date of service:  Time of service:
Person Name:
served Date of birth:
[Person bound,
or person
protected by the Signature: …………………………………………….
order] (If possible to obtain)
Certificate I certify that on the day and at the time and place set out above:
I personally served this summons on the person to be summonsed
I posted this summons to the person to be summonsed
I took the steps directed by the court to effect substituted service of this
summons on the person to be summonsed in accordance with the
Restraining Orders Act 1997 Part 6 Division 2.
Signature:  Date:

OR

3046 GOVERNMENT GAZETTE, WA 20 June 2017

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Summons Name of person attempting to serve summons:
not served I am:
 the registrar of the court

 a police officer  a prison officer

Rank, number and station: _______________________

Prison: ______________________________________

a person authorised by the registrar Date of authorisation: ____________
Attempted method of service:   personal  by post  substituted service
Steps taken to attempt service: 

I was unable to serve this summons because:

 the person to be summonsed does not appear to live or work at the addresses

given and cannot be found elsewhere

 the person to be summonsed appears to be deliberately avoiding being served

with this summons  other [give details] Signature: Date:

Please return this proof of service copy of the summons to the court before the hearing date, even if you have been unable to serve it.

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Form 14 Restraining order made during other proceedings

record of proceedings

Proceedings in which order made:

Restraining Orders Act 1997 s. 63

Jurisdiction:

Restraining order made

Location:

during other proceedings

Record of proceedings

Application Type of order:
Family Violence Restraining Order
Violence Restraining Order

Order made:

by court of its own motion
on an application or request by

Charges to which order relates: ______________________________________________

Person Family name: Date of birth:
protected by Other names:
the order Address: street:
suburb:  postcode:
Phone nos.: work:  home: mobile:

Role in proceeding in which restraining order was made:

applicant/prosecutor
victim
respondent/accused
other witness
other ____________________________________
Person who Family name: Date of birth:
is bound by Other names:
the
Home street:
restraining
address:  suburb: postcode:
order 
Work  street:
address:  suburb: postcode:
Phone nos.:  work: home: mobile:
Role in proceeding in which restraining order was made:
respondent/accused
other witness
other _____________________________________
Grounds on For FVROs: conviction for a violent personal offence listed in section 63(4AA)
which order family member wants to be protected by FVRO
applied for or

For VROs: [specify grounds]

considered

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Family Are there any current family orders relating to the person who is
orders bound by the restraining order’s rights in relation to children who
may be affected by a restraining order?  Yes  No
Are there any current Family Court proceedings in which such
orders are being sought?  Yes  No
Details of family order or proceedings:
Firearms Does the person who is bound by the restraining order have a firearm or a firearms licence?
 Yes  No
Does the person who is bound by the restraining order have access to a firearm at work?
 Yes  No
Witness and Person protected by the restraining order:
summary of
evidence Person who is bound by the restraining order:
Other people:
Other notes
Terms of
the order
Order made
Date order made:  Time order made:
Registrar 
Signature:  Date:
20 June 2017 GOVERNMENT GAZETTE, WA 3049

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Form 15 Application to register an interstate restraining order

Part A Application to register an interstate restraining order

Number:

Restraining Orders Act 1997 s. 75

Interstate restraining order Jurisdiction:
Location:

Application to register

Applicant Are you:
[If not the
 the person to be protected  the parent or guardian of a child to be protected
person seeking
 a police officer  the legal guardian of a person to be protected
to be protected]
Family name:  Date of birth:
Other names:
Address: street:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Person to be Family name: Date of birth:
protected by Other names:
the order
Address: street:
suburb:  postcode:
Phone nos.: work:  home: mobile:
Person who is Family name: Date of birth:
to be bound Other names:
by this order Home street:
[Fill in as many address:
suburb:  postcode:
details as you  Work street:
can
address: suburb:  postcode:
Phone nos.: work:  home: mobile:
Interstate State where order was made:
Order Court in which order was made:
Date order was made:  Order/matter no.:
Does the order relate to family violence?
Notice 
 do  do not want notice of the registration of this order to be given to the person who
is bound by this order
Applicant 
Signature:  Date:
Registered 
Date of registration:  Time of registration:
[To be filled in 
Registrar:  Date:
by the court
Notification  I certify that on __ __/__ __/__ __ at ______ am/pm at _______________________________
[To be filled in  I notified the applicant that the order had been registered.
by the court
Registrar:

When you lodge this application you must also give the registrar the original interstate order or a copy certified to be a true copy by an officer of the court in which it was made. The registrar may also ask for evidence to show that the interstate order has been served on the person who is to be bound by the order.

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Form 15 Application to register an interstate restraining order Part B Information to be on the copy of the application given to

the applicant

Notification to applicant

The interstate restraining order described in this form has been registered in Western
Australia. It can now be enforced in this State as if it had been made here.

Form 15 Application to register an interstate restraining order Part C Information to be on the copy of the application given

to the Commissioner of Police

Notification to the Commissioner of Police

The interstate order described in this form has been registered in Western Australia.
A copy of the interstate order is attached.

Form 15 Application to register an interstate restraining order Part D Information to be on the copy of the application given

to the interstate court where the relevant interstate order was

made

Notification to the Registrar

The restraining order described above and made in your court has been registered in registrar of the court mentioned above.

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Form 16 Restraining order summons Part A Restraining order summons

Restraining Orders Act 1997 Number:
s. 26(3) and 39 Jurisdiction:
Restraining order Location:

Summons

An application has been made for a restraining order against you. The details of the application are set out below. You are required to attend a court hearing on this matter at the place and time set out below.

Respondent Family name: Date of birth
Other names:
Home street:
address: 
suburb:  postcode:
Work  street:
address: 
suburb:  postcode:
Phone nos.: work:  home: mobile:
Person Family name: Date of birth
seeking to be Other names:
protected
Applicant The applicant is: person seeking to be protected
[If not the
person seeking
parent or guardian of a child who is seeking to be protected

 a police officer

to be protected] the legal guardian of a person seeking to be protected

Family name: Other names:

Type of order The application is for:  Family Violence Restraining Order
 Violence Restraining Order
 Misconduct Restraining Order

Grounds for application

Hearing Court: Date: Time:
Registrar:

If you do not attend the court hearing a restraining order may be made against or a firearms licence.

you in your absence.
A restraining order may prohibit you from going to certain places (such as the
home of the person seeking to be protected) and place other restrictions on
where you may go and what you may do.

3052 GOVERNMENT GAZETTE, WA 20 June 2017

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Form 16 Restraining order summons

Part B Information to be on the proof of service copy

Certificate of service

Restraining order no.:

Court of issue:

Person Name of person serving summons:
serving I am:
summons
the registrar of the court
a police officer Rank, number and station: _____________________________
a prison officer Prison: ____________________________________________
a person authorised by the registrar Date of authorisation: ____________________
Service
Method of service:   personal  by post  substituted service
Place where summons served:
Date of service:  Time of service:
Person  Name:
served  Date of birth:
[Person bound 
or person 
protected by the  Signature: …………………………………………….
order (If possible to obtain)
Certificate  I certify that on the day and at the time and place set out above:
I personally served this summons on the person to be summonsed
I posted this summons to the person to be summonsed
I took the steps directed by the court to effect substituted service of this summons on
the person to be summonsed in accordance with the Restraining Orders Act 1997
Part 6 Division 2.
Signature:  Date:

OR

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Magistrates Court (Civil Proceedings) Amendment Rules 2017

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Summons Name of person attempting to serve summons:
not served I am:
the registrar of the court
a police officer Rank, number and station: _______________________________
a prison officer Prison: ______________________________________________
a person authorised by the registrar Date of authorisation: __________________
Attempted method of service:   personal  by post  substituted service
Steps taken to attempt service:
I was unable to serve this summons because:
the person to be summonsed does not appear to live or work at the addresses given
and cannot be found elsewhere
the person to be summonsed appears to be deliberately avoiding being served with
this summons

 other [give details]

Signature:  Date:

Please return this proof of service copy of the summons to the court before the hearing date, even if you have been unable to serve it.

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Form 17 Application to have final order under section 32(2) of

the Act set aside

Restraining Orders Act 1997 s. 32(5) Number:
Application to set aside final
order under the Jurisdiction:

Restraining Orders Act 1997

Location:

section 32(2)

Applicant’s Family name: Date of birth:
details Other names
Home street:
address: suburb:  postcode:
Phone nos.: work:  home: mobile:
Respondent’s Family name: Date of birth:
details Other names
Home street:
address: suburb:  postcode:
Phone nos.: work:  home: mobile:
Details of  Family violence restraining order
final order  Violence restraining order
Date of This application is made within 21 days from the date that I was notified that the interim
application order had become a final order
This application is not made within 21 days from the date that I was notified that the
interim order had become a final order
Application I apply for the following orders —
Leave be granted to proceed with this application out of time
The final order be set aside
Grounds for I rely on the following grounds in support of this application.
application [Outline grounds, if insufficient space please attach further information.]
Signature of Date
applicant
Notice
of Court:
court hearing Address:
Date and time of hearing:
20 June 2017 GOVERNMENT GAZETTE, WA 3055

Magistrates Court (Civil Proceedings) Amendment Rules 2017

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Form 18 Application to have decision under section 42 of the

Act set aside

Restraining Orders Act 1997 s. 43A Number:

Application to set aside

Jurisdiction:

decision under the

Restraining Orders Act 1997

Location:

section 42

Applicant’s Family name: Date of birth:
details Other names
Home street:
address: suburb:  postcode:
Phone nos.: work:  home: mobile:
Respondent’s Family name: Date of birth:
details Other names
Home street:
address: suburb:  postcode:
Phone nos.:  work: home: mobile:
Order to  Family violence restraining order
which this  Violence restraining order
application
relates

Date of decision

Date of
This application is made within 21 days from the date that I first became aware of/was
application served with a copy of the order
This application is not made within 21 days from the date that I first became aware
of/was served with a copy of the order
Application I apply for the following orders —
Leave be granted to proceed with this application out of time.
The decision and orders made in this matter on the date above be set aside.
Grounds for I rely on the following grounds in support of this application.
application [Outline grounds, if insufficient space please attach further information.]
Signature of
applicant
Notice
Date
of Court:
court hearing Address:
Date and time of hearing:

S. HEATH, Chief Magistrate, Magistrates Court in Perth.

Date 16 June 2017.

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