Restraining Orders Amendment Regulations 2004 (WA)

PRINT POST APPROVED PP665002/00041

WESTERN	5257
AUSTRALIAN GOVERNMENT

ISSN 1448-949X

PERTH, FRIDAY, 26 NOVEMBER 2004 No. 198 SPECIAL

PUBLISHED BY AUTHORITY JOHN A. STRIJK, GOVERNMENT PRINTER AT 3.00 PM

© STATE OF WESTERN AUSTRALIA

RESTRAINING ORDERS ACT 1997

_________

RESTRAINING ORDERS

AMENDMENT REGULATIONS

26 November 2004 GOVERNMENT GAZETTE, WA 5259

Restraining Orders Act 1997

Restraining Orders Amendment

Regulations 2004

Made by the Governor in Executive Council.

1.	Citation These are the Restraining Orders Amendment Regulations 2004.
2.	Commencement These regulations come into operation on 1 December 2004.

3.             The regulations amended

The amendments in these regulations are to the Restraining
Orders Regulations 1997*.

[* Reprint 1 as at 13 February 2004.]

4.	Regulation 2A inserted After regulation 2 the following regulation is inserted —
“

2A. Interpretation
In these regulations —
“approved” means approved in writing by the Chief

Executive Officer of the department of the Public

5260 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 5

Service principally assisting the Minister in the administration of the Act;

“form” followed by a designation means the form of

that designation in Schedule 1;
“proceedings under the Act” means —

(a)	the hearing of an application; or
(b)	proceedings for an offence against the Act;

“restrained person”, in relation to a restraining order,

means the person who is bound by the order.

”.

5.             Regulation 3 amended

Regulation 3(2) is repealed and the following subregulation is inserted instead —

“

(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.

”.

6.             Heading to Part 2 amended

The heading to Part 2 is amended by inserting after “Firearms” the following —

“ and other weapons ”.

7.             Regulation 5 amended

Regulation 5(1) is amended by deleting “section 15” and inserting instead —

“ section 62E ”.

26 November 2004	GOVERNMENT GAZETTE, WA	5261
Restraining Orders Amendment Regulations 2004

r. 8

8.             Regulations 5A and 5B inserted

After regulation 5 the following regulations are inserted in
Part 2 —

“

5A.	Dealing with firearms seized under section 62B(2)(c) of the Act
A firearm seized under section 62B(2)(c) of the Act is to be dealt with in the same manner as a firearm seized under section 24(2) of the Firearms Act 1973.
5B.	Dealing with other weapons seized under section 62B(2)(c) of the Act
A weapon, other than a firearm, seized under section 62B(2)(c) of the Act is to be dealt with under sections 15, 16, 17 and 18 of the Weapons Act 1999 in the same manner as a weapon seized under that Act.

”.

9.             Regulation 6 amended

Regulation 6 is amended by deleting “Form 5.” and inserting instead —

“ Form 7. ”.

10.           Regulations 6A, 6B, 6C and 6D inserted After regulation 6 the following regulations are inserted —

“

6A. Application to correct minor error in restraining
orders — section 49A of the Act

(1) An application to the court under section 49A of the
Act for an order correcting a restraining order is to be
made in the form approved.

5262 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 10

(2)	Subject to subregulation (3), an application under subregulation (1) is to be heard in the absence of the other party to the order.
(3)	If the court hearing an application so orders, the hearing is to be adjourned and notice of the application is to be given to the other party to the order.
(4)	Where an order is made under subregulation (3), the clerk is to ensure that the other party to the restraining order is given notice of the application, and is to fix a hearing and summons both parties to the hearing.
(5)	A copy of a restraining order corrected under section 49A of the Act is to be —

(a)	served on the person who is bound by the restraining order;
(b)	delivered to —

(i)      the person protected by the order; or

(ii) the parent or guardian of that person, if behalf of that person;
the parent or guardian made the

(c)	delivered to the Commissioner of Police; and
(d)	placed on the court’s records.

(6) The correction of restraining order under section 49A
of the Act does not affect the time when the restraining
order came into force or the duration of the restraining
order.

6B. Order that child be allowed to give oral evidence —
section 53A of the Act

(1) A party to a restraining order, or a person charged with
an offence against the Act, may apply to the court for
an order that a child be allowed to give oral evidence at

26 November 2004	GOVERNMENT GAZETTE, WA	5263
Restraining Orders Amendment Regulations 2004

r. 10

any proceedings under the Act specified in the

application.

(2)	An application referred to in subregulation (1) is to be made at least 14 days before the proceedings.
(3)	An application referred to in subregulation (1) is to be made in the form approved.
(4)	If an application referred to in subregulation (1) is made, the clerk is to give notice of the application to all other parties to the proceedings.

6C. Attendance at hearings

(1) For the avoidance of doubt, a person is not to be taken
to have failed to attend a hearing if the person is
represented at the hearing by —

(a)	a legal practitioner; or
(b)	a police officer, who made the application on behalf of the person, or who is conducting proceedings on the person’s behalf under section 62G of the Act.

(2) Subregulation (1) does not apply if the person has
failed to attend a hearing —

(a)	after being summonsed; or
(b)	where, in the opinion of the court, the hearing cannot take place without the physical presence of the person.

5264 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 11

6D.	Certificate to the effect that the person who is bound by a restraining order was present in court when the order was made — section 55(3a) of the Act
Where a person bound by a restraining order is present in court when the order is made, the clerk of the court is to certify that this was so, in the form approved.

”.

11.	Regulation 11 repealed Regulation 11 is repealed.
12.	Part 5 inserted After regulation 12 the following Part is inserted —
“

Part 5 — General

13.           Property that may be recovered when restraining order made — section 13(5) of the Act

For the purposes of section 13(5) of the Act, property that may be recovered by a person from a place specified in a violence restraining order may include any, or all, of the following —

(a)	property that is used by the person to earn income;
(b)	personal property of a child of the person;
(c)	property that is wholly, or partly, the property of the person and that is used for, or by, a child of the person;
(d)	property that the other party to the restraining order has agreed that the person may recover.

26 November 2004	GOVERNMENT GAZETTE, WA	5265
Restraining Orders Amendment Regulations 2004

r. 12

14.           Procedures for recovering property under terms of a violence restraining order — section 13(5)(b) of the Act

(1)	For the purposes of section 13(5)(b) of the Act, the procedures set out in this regulation are the procedures in accordance with which property specified in a violence restraining order is to be recovered from a place specified in that order.
(2)	Subject to subregulation (4), the person seeking to recover the property is to negotiate a mutually convenient time for the recovery of the property with a person who has lawful access to the property.
(3)	Subject to subregulation (4), if agreement as to the recovery of the property is reached, the person seeking to recover the property is to recover the property in accordance with that agreement.
(4)	If the person seeking to recover the property is unable to negotiate a mutually convenient time for the recovery of the property, or to carry out an agreement reached as to the recovery of the property, due to the terms of the violence restraining order, or for any other reason, the person wishing to recover the property may seek the assistance of a police officer.

15.           Exchange of information — section 70A of the Act

For the purposes of section 70A of the Act, the following information about a person protected by a violence restraining order, or a child affected by such an order, is prescribed information —

(a) the name, address, telephone number, age and ethnicity and other details of —

(i)      the person or child;

5266 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 12

(ii)      a person who is bound by the violence restraining order; or

(iii) an offender or alleged offender violence restraining order;
responsible for, or involved in, any

(b)	a description of any offence relevant to the granting of the violence restraining order and an abridged description of the circumstances of its commission;
(c)	any information about the grounds on which the violence restraining order was granted;
(d)	the name, rank and any other relevant identifying information of any police officer in charge of investigating any offence relevant to the granting of the violence restraining order;
(e)	the police station or office where information is held —

(i)      about the investigation of any offence relevant to the granting of the violence restraining order or the breach of that

order; or

(ii)      about the grounds on which the order was granted;

(f) the status of the investigation and prosecution of any offence relevant to the granting of the violence restraining order by a police officer.

”.

26 November 2004	GOVERNMENT GAZETTE, WA	5267
Restraining Orders Amendment Regulations 2004

r. 13

13.           Schedule 1 replaced

Schedule 1 is repealed and the following Schedule is inserted instead —

“

Schedule 1 — Forms

[r. 3]

Table of forms

Forms about violence restraining orders

Form Provisions of Act

1	Application for violence restraining order	Section 25
2	Part A — Violence restraining order	Sections 29, 32, 43,
Part B — Information to be on the copy of order given to the person who is	49, 63 and 66

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	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

4	Application for misconduct restraining order	Section 38
5	Part A — Misconduct restraining order	Part 4 Divisions 1
Part B — Information to be on the copy of the order given to the person who is	and 2, sections 49

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

6	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

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

5268 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Forms about variation and cancellation of orders

Form Provisions of Act

8	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

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

Forms for police orders

Form Provisions of Act

10	Police order	Part 2 Division 3A
Part A — Police order Part B — Information to be on the proof of service copy Part C — Information to be on copy of police order given to the person bound

by a police order

Part D — Information to be on copy of police order given to a person

protected by a police order

Other forms

Form Provisions of Act

11	Restraining order made during other proceedings — Record of proceedings	Section 63
12	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

13	Part A — Restraining order — Summons	Sections 26(3)
Part B — Information to be on the proof of service copy	and 39
14	Application to have decision under section 42 of the Act set aside	Section 43A

26 November 2004	GOVERNMENT GAZETTE, WA	5269
Restraining Orders Amendment Regulations 2004

r. 13

Form 1 — Application for violence restraining order

Restraining Orders Act 1997 s. 25	Number:
Violence restraining order	Jurisdiction:

Application Location:

Person seeking	Family name:	Date of birth:
to be protected	Other names:

Address:	street:
suburb:  postcode:

Phone nos.:  work: home:

Applicant	Are you: !	the person seeking to be protected
[If not the person	!	the parent or guardian of a child who is the person seeking to be protected
seeking to be	!	a child welfare officer on behalf of a child who is seeking to be protected
protected]	!	a police officer
!	the 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:

Respondent	Family name:	Date of birth:
[Fill in as many	Other names:
details as you can.]	Home	street:

address: suburb:	postcode:
Work	street:
address: suburb:	postcode:

Phone nos.:  work home:

Grounds for Why do you need a violence restraining order? To prevent the respondent from —

application	!	committing an act of abuse against the person seeking to be protected;
!	behaving in a way that could reasonably be expected to cause fear that a person seeking to be protected will have an act of abuse committed against him or her;
!	exposing a child to an act of family and domestic violence; or
!	behaving in a way that could reasonably be expected to cause fear that a child will be exposed to an act of family and domestic violence.

Give details of the respondent’s behaviour.

Family orders	Are there any current family orders relating to the respondent’s rights in	! Yes ! No ! Unknown
[If yes, see the	relation to children who may be affected by a restraining order?
Details of family	Are there any current Family Court proceedings in which such orders	! Yes ! No ! Unknown
order Annexure.]	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 by filled in by
the court.]	Signature of clerk:

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

Affidavit evidence may be provided on request

If you, or the respondent, request a copy of any affidavit received in evidence in relation to this application the clerk of courts where this application is made is to provide a copy of the affidavit to the person who made the request.

5270 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — Violence restraining order Part A — Violence restraining order

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

Violence Jurisdiction:

Restraining Order Location:

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:

Person protected	Family name:	Date of Birth:
Other names:

Type of order	The order is	! for 72 hours or less	! an interim order	! a final order
Terms of this order

Order made	Date order made:	Time order made:
Clerk	Signature:	Date:
26 November 2004	GOVERNMENT GAZETTE, WA	5271
Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — 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 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 duration period set out in the order.

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 and domestic relationship (eg. 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 and support 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 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. conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

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.
If you do not object to this order being made final you should fill in the “Consent” 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. 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 no period is specified for 2 years, 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 assume that you do
not object and the interim order will automatically become a final order.

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 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, 2 years 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 information conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

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

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 clerk of courts 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

5272 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — 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 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. Remember 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.

and return this copy of the order to the court within 21 days of the date it was served on you.

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

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. I understand
that this interim order will automatically become a final order which will stay in force for the
period specified in the order, or if no period is specified for 2 years, from the date on which this
interim order was served on me.

Signature:  Date:

26 November 2004	GOVERNMENT GAZETTE, WA	5273
Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — 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 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 duration period set out in the order.

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

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 if no period is specified 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.

Counselling and support services may be of assistance to you.

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, 2 years after this final order comes into force;

• 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 clerk 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 he or she may be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, or both.

Counselling and support 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 clerk of courts 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

5274 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — 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 clerk of the court

order ! a police officer Name and other identifying information: _________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk Date of authorisation: _______________________

Service	Method of service: ! personal	! oral	! by post	! substituted service
Place where order served:

Date of service:  Time of service:

Person served	Name:
[Person who is	Date of birth:
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 Part 6 Division 2 of the Restraining Orders Act 1997.

In the case of oral service, I also certify that I gave the person who is bound by this order the information
required by section 55(5) of the Restraining Orders Act 1997 and that he or she appeared to understand what
was said.

Signature:  Date:

26 November 2004	GOVERNMENT GAZETTE, WA	5275
Restraining Orders Amendment Regulations 2004

r. 13

Form 2 — 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	Name:
to 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) is aware of them.]
Current	Court:  Family Court matter no.:
proceedings for	Terms of family order being sought which relate to the respondent’s rights in relation to children:
family order
Are these terms of the order being opposed? ! Yes ! No ! Unknown
Applicant	Signature:  Date:

5276 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 3 — 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 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:

Person protected	Family name:	Date of Birth:
Other names:

Lifelong order	This order remains in force for the period of the life of the person who is bound by this order.
Terms of this order
Order made	Date order made:  Time order made:
Clerk	Signature:  Date:

26 November 2004	GOVERNMENT GAZETTE, WA	5277
Restraining Orders Amendment Regulations 2004

r. 13

Form 3 — 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 section 63A of the Restraining Orders Act 1997. 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 and domestic relationship (eg. 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 and support 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

Form 3 — 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 section 63A of the Restraining Orders Act 1997. 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 his or her life.

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

Counselling and support 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

5278 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 4 — Application for misconduct restraining order

Restraining Orders Act 1997 s. 38(2) Number:

Misconduct restraining order Jurisdiction:

Application Location:

Person seeking	Family name:	Date of birth:
to be	Other names:
protected	Address:	street:
suburb:  postcode:

Phone nos.:  work: home:

Applicant	Are you: !	the person seeking to be protected
[[If not the person	!	the parent or guardian of a child who is seeking to be protected
seeking to be	!	a police officer
protected]	!	the 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:

Respondent	Family name:	Date of birth:
[Fill in as many	Other names:
details as you can.]	Home	street:

address: suburb:	postcode:
Work	street:
address: suburb:	postcode:

Phone nos.:  work: home:

Grounds for Why do you need a misconduct restraining order? Because the respondent is likely to:

application	!	behave in a manner that is intimidating or offensive to a person seeking to be protected;
!	damage property owned by, or in the possession of, the person seeking to be protected; or
!	behave in a manner that is, or is likely to lead to, a breach of the peace.

Give details of the respondent’s behaviour.

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 by filled in by
the court.]	Signature of clerk:

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

26 November 2004	GOVERNMENT GAZETTE, WA	5279
Restraining Orders Amendment Regulations 2004

r. 13

Form 5 — Misconduct restraining order Part A — Misconduct restraining order

Restraining Orders Act 1997 s. 43, 49 and 63 Number:

Misconduct Jurisdiction:

Restraining Order Location:

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:

Person protected	Family name:	Date of birth:
Other names:
Terms of the order
Order made	Date order made:	Time order made:
Clerk	Signature:	Date:

5280 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 5 — 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. conviction will face a penalty of up to $1 000.

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 clerk of the court.

Counselling and support 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 clerk of courts 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

Form 5 — 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. or she may be arrested and on conviction will face a penalty of up to $1 000.

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 clerk of the court.

Counselling and support 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 clerk of courts 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

26 November 2004	GOVERNMENT GAZETTE, WA	5281
Restraining Orders Amendment Regulations 2004

r. 13

Form 5 — 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 ! the clerk of the court

order ! a police officer Rank, number and station: _____________________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk Date of authorisation: _______________________

Service	Method of service: ! personal	! oral	! by post	! substituted service
Place where order served:

Date of service:  Time of service:

Person served	Name:
[Person who is	Date of birth:
bound 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 order on the person who is bound by the order
!	I orally served this order on the person who is bound by the order
!	I posted this order to the person who is bound by the order
!	I took the steps directed by the court to effect substituted service of this order on the person who is bound by the order in accordance with Part 6 Division 2 of the Restraining Orders Act 1997.

In the case of oral service, I also certify that I gave the person who is bound by this order the information
required by section 55(5) of the Restraining Orders Act 1997 and that he or she appeared to understand what
was said.

Signature:  Date:

5282 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — Telephone order
Part A — Court copy of telephone order

Restraining Orders Act 1997 s. 23	Number:
Telephone Violence	Jurisdiction:
Restraining Order	Location:

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:

Protected	Family name:	Date of birth:
person	Other names:

Type of order	The order is	! 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 above

by Magistrate	Signature:	Date:
26 November 2004	GOVERNMENT GAZETTE, WA	5283
Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — 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 Violence	Jurisdiction:
Restraining Order	Location:

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:

Person protected	Family name:	Date of birth:
Other names:

Type of order	The order is	! 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:

5284 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — 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 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 duration period set out in the order.

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 and domestic relationship (eg. 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 and support 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 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.
both.
You have an opportunity to object to the order before it becomes a final order. be arrested and on conviction will face a penalty of up to $6 000 or imprisonment for 2 years, 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.
If you do not object to this order being made final you should fill in the “Consent” 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. 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 no period is specified for 2 years, 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 assume that you do not object and the interim order will automatically become a

final order.

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 clerk of courts where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

26 November 2004	GOVERNMENT GAZETTE, WA	5285
Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — 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. Remember 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.

and return this copy of the order to the court within 21 days of the date it was served on you.

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

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. I understand
that this interim order will automatically become a final order which will stay in force for the
period specified in the order, or if no period is specified for 2 years, from the date on which this
interim order was served on me.

Signature:  Date:

5286 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — 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 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 duration period set out in the order.

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

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.
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 if no period is
specified 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.

Counselling and support 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 clerk of courts where the application for the order was made is to provide a copy of the affidavit to the person who made the request.

26 November 2004	GOVERNMENT GAZETTE, WA	5287
Restraining Orders Amendment Regulations 2004

r. 13

Form 6 — Telephone order

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

Certificate of Service

Restraining order No:

Court of issue:

Name of person serving order:

I am

! the clerk of the court

! a police officer Name and other identifying information: _________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk Date of authorisation: _______________________

Service	Method of service: ! personal	! oral	! by post	! substituted service
Place where order served:

Date of service:  Time of service:

Person served	Name:
[Person who is	Date of birth:
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 Part 6 Division 2 of the Restraining Orders Act 1997.

In the case of oral service, I also certify that I gave the person who is bound by this order the information
required by section 55(5) of the Restraining Orders Act 1997 and that he or she appeared to understand what
was said.

Signature:  Date:

5288 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 7 — 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:
Reason for applying by telephone	I  ! am ! am not satisfied that the matter is sufficiently urgent to justify a telephone application.
Person seeking	Family name: Date of birth:
to be	Other names:
protected	Address:  street:

suburb:  postcode:

Phone nos.: work:  home:

Applicant	The applicant is:	! person seeking to be protected
! parent or guardian of a child who is seeking to be protected
[If not the	! a child welfare officer on behalf of a child who is seeking to be protected
person seeking to	! authorised person
be protected]	! 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:

Respondent	Family name:	Date of birth:
Other names:

Home	street:
address:	suburb:  postcode:
Work	street:
address:	suburb:  postcode:
Phone nos.: work:	home:

The respondent	! is	! is not present
! is	! is not being detained by a police officer

Grounds for application

Family

Are there any current family orders relating to the respondent’s

orders

rights 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

26 November 2004	GOVERNMENT GAZETTE, WA	5289
Restraining Orders Amendment Regulations 2004

r. 13

Witnesses	Applicant:
and
summary of
evidence	Respondent:
Authorised person:
Other people:
Other notes
Decision and	I ! am ! am not satisfied that a telephone order should be made.
order	The terms of the order are:
Magistrate	Name:
Court where Magistrate is based:
Magistrate’s location when hearing application:
Signature:  Date: Time:

5290 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 8 — Application to vary or cancel a restraining order Part A — Application to vary or cancel a restraining order

Restraining Orders Act 1997 s. 45	Number:
Restraining order	Jurisdiction:

Application to vary or cancel	Location:
Person	Family name:
applying to
vary or	Other names:
cancel	Address:  street:

suburb:  postcode:

Phone nos.:	work:	home:
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: ! Violence Restraining Order ! Misconduct Restraining Order

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 continue the
leave to	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 restraining order to be ! cancelled ! varied
cancellation	If varied, what do you want changed?
Grounds for	Why do you want the restraining order varied or cancelled?
variation or cancellation
Hearing	Court:
[To be filled in by	Date:
the court]
Time::
Notification	I certify that on __ __/__ __/__ __ __ __ at _____ am/pm at ______________________________________
[To be filled in by	I notified the person applying to vary or cancel of the hearing date.
the court]	Signature of clerk:

26 November 2004	GOVERNMENT GAZETTE, WA	5291
Restraining Orders Amendment Regulations 2004

r. 13

Form 8 — 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:

(i) made (this does not apply in respect of a hearing where you were not present

you had a reasonable cause not to attend a prior hearing where the restraining order was under section 26 of the Restraining Orders Act 1997);

(ii)  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 his or her actions has persistently attempted to cause you to breach the order;

(iii) there has been a substantial change in the relevant circumstances since the order was made; or

(iv) 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 attend the hearing, your application may be dismissed.
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 the court is satisfied that one of the grounds set out above applies to you then the court will 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.

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, despite anything else in the Restraining Orders Act 1997, THE ORDER WILL NOT EXPIRE before the application is determined if the person bound by the order has been given a copy of this application.

5292 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 9 — Summons to vary or cancel restraining order Part A — Summons to vary or cancel restraining order

Restraining Orders Act 1997 s. 47	Number:
Restraining order	Jurisdiction:
Summons to vary or cancel	Location:

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:

Restraining ! Violence Restraining Order Date order made:

order ! Misconduct Restraining Order Date order served:

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]
Signature of clerk:

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

26 November 2004	GOVERNMENT GAZETTE, WA	5293
Restraining Orders Amendment Regulations 2004

r. 13

Form 9 — 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 ! the clerk of the court

summons ! a police officer Rank, number and station: _____________________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk 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
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 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 Part 6 Division 2 of the Restraining Orders Act 1997.
Signature:	Date:

OR

Summons not	Name of person attempting to serve summons:
served	I am ! the clerk of the court

! a police officer Rank, number and station: ______________________________

!	a prison officer Prison: _____________________________________________
!	a person authorised by the clerk 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.

5294 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 10 — Police order Part A — Police order

Restraining Orders Act 1997 Part 2 Division 3A.

Police 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:

Person protected	Family name:	Date of birth:
Other names:

Type of order	This order is a	!	24 hour police order
!	72 hour police order
Terms of the order

Order made Date order made: Time order made:

Order expires	This order will expire at am/pm on the day of 20
Issuing police	Name and other identifying information:
officer
Signature:

26 November 2004	GOVERNMENT GAZETTE, WA	5295
Restraining Orders Amendment Regulations 2004

r. 13

Form 10 — Police order
Part B — Information to be on the proof of service copy
Certificate of Service

Person served	Name:
(Person who is	Date of birth:
bound by the	Signature:
order)
Consent for 72	Order for the protection of an adult
hour police	I,…………………………………………………….. Date of birth …………………………
order	(name of person protected by the police order) consent to the making of this 72 hour police order.
Signature…………………….
Order for the protection of a child
I,………………………..the parent/ guardian* of the child to be protected by this police order consent to the making of this order.
Signature…………………….
OR
! a child welfare officer * consents to the making of this order. Name and other identifying information ……………………. *Delete as applicable
Details of	Place where order served:
Service	Date of service:  Time of service:
Officer	Name and other identifying information:
servicing order
I certify that on the day and at the time and place set out above:

!	I personally served this order on the person bound by this order
!	I gave the explanation required by section 30E(3) of the Restraining Orders Act 1997 to the person bound by this order and the person protected by this order

Signature:
Date:

5296 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 10 — Police order
Part C — Information to be on the copy of order given to the person bound

by a police order

PERSON BOUND BY THIS ORDER

IMPORTANT INFORMATION

This is a police order which has been made against you.
In this police order you are referred to as the person who is bound by this order.
This police order came into force when it was served on you.
You must comply with the terms of this order until it expires.
The date and time of expiry are written on the front of this order.
The terms of this police order are written on the front of this order. You should read the terms
carefully so that you are aware of the restraints that have been imposed on you — this means
that you are not to do certain things.

This police order has been issued to —

• ensure that a person is protected from acts of family and domestic violence;

• prevent behaviour that could reasonably be expected to cause fear that a person will have committed against them an act of family and domestic violence; or

• ensure that children are not exposed to acts of domestic violence.

Penalty: It is an offence to breach a police 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 and domestic relationship (eg. 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 and support services may be of assistance to you.

26 November 2004	GOVERNMENT GAZETTE, WA	5297
Restraining Orders Amendment Regulations 2004

r. 13

Form 10 — Police order
Part D — Information to be on the copy of a police order given to a person protected

by a police order

IMPORTANT INFORMATION

FOR PERSON PROTECTED BY A POLICE ORDER

This is a police order which has been made for your benefit.
In this police order you are referred to as the person protected.
This police order came into force when it was served on the person who is bound by the order.
The person bound by this order must comply with the terms of this order until it expires.
The date and time of expiry are written on the front of this order.
The terms of this police order are written on the front of this order. You should read the terms
carefully so that you are aware of the restraints that have been imposed to protect you.

This police order has been issued to —

• ensure that a person is protected from acts of family and domestic violence;

• prevent behaviour that could reasonably be expected to cause fear that a person will have committed against them an act of family and domestic violence; or

• ensure that children are not exposed to acts of domestic violence.

The person bound by this order commits an offence if he or she fails to comply with this order.

You must not —

• invite or encourage the person bound by this order to breach this order; or

• by your actions cause the person bound by this order to breach the order.

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

Counselling and support services may be of assistance to you.

5298 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 11 — Restraining order made during other proceedings — record of proceedings

Restraining Orders Act 1997 s. 63	Number:
Restraining order made	Jurisdiction:
during other proceedings	Location:

Record of proceedings

Application Order made: ! by Court of its own motion ! on an application or request by

Person protected	Family name:	Date of birth:
by the order	Other names:

Address:	street:
suburb:  postcode:

Phone nos.:  work: home:

Role in proceeding in which restraining order was made:

! applicant/complainant ! respondent/defendant

! other witness ! other

Person who is	Family name:	Date of birth:
bound by the	Other names:
restraining order	Home	street:
address:	suburb:  postcode:
Work	street:
address:	suburb:  postcode:

Phone nos.:  work home:

Role in proceeding in which restraining order was made:

! applicant/complainant	! respondent/defendant
! other witness	! other_______________________________________________

Grounds on which order applied for or considered

Family

Are there any current family orders relating to the person who is bound by the restraining order’s rights

orders

in relation to children who may be affected by a restraining order?	! Yes	! No
Are there any current Family Court proceedings in which such	! Yes	! No

orders are being sought?
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 restringing order have access to a firearm at work? ! Yes ! No

Witness

Person protected by the restraining order:

and

summary of

Person who is bound by the restraining order:

evidence

ther people:

26 November 2004	GOVERNMENT GAZETTE, WA	5299
Restraining Orders Amendment Regulations 2004

r. 13

Other notes

Terms of the

order

Order made	Date order made:	Time order made:
Clerk	Signature:	Date:

5300 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 12 — Application to register an interstate restraining order Part A — Application to register an interstate restraining order

Restraining Orders Act 1997 s. 75	Number:
Interstate restraining order	Jurisdiction:
Application to register	Location:

Person to be	Family name:	Date of birth:
protected by the
order	Other names:

Address:	street:
suburb:  postcode:

Phone nos.:  work: home:

Applicant	Are you:	! the person to be protected	! the parent or guardian of a child to be protected
! a police officer	! the legal guardian of a person to be protected

[If not the	Family name:	Date of birth:
person seeking to
be protected]	Other names:

Address:	street:
suburb:  postcode:

Phone nos.:  work: home:

Person who is to	Family name:	Date of birth:
be bound by this	Other names:
order

Home	street:
address:	suburb:  postcode:

[Fill in as many

details as you	Work	street:
can]	address:	suburb:  postcode:

Phone nos.:  work: home:

Interstate	State where order was made:
order	Court in which order was made:
Date order was made:  Order/matter no.:
Notice	I  ! do ! do not want notice of the registration of this order given to the person who is to be

bound by this order

Applicant	Signature:	Date:
Registered	Date of registration:	Time of registration:
[To be filled in by
Signature of clerk:	Date:
the court]

Notification	I certify that on __ __/__ __/__ __ __ __ at ______ am/pm at _____________________________________
[To be filled in by	I notified the applicant that the order had been registered.
the court]	Signature of clerk:

When you lodge this application you must also give the clerk 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 clerk 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.

26 November 2004	GOVERNMENT GAZETTE, WA	5301
Restraining Orders Amendment Regulations 2004

r. 13

Form 12— 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 12— 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 copy of the interstate order is attached.

Form 12 — 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 or Clerk the court mentioned above.

The restraining order described above and made in your court has been registered in

5302 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 13 — Restraining order — summons Part A — Restraining order — summons

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

Summons Location:

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: Other names:
Home street:
address:  suburb: postcode:
Work  street:
address:  suburb: postcode:
Phone nos.:  work: home:
Person seeking	Family name:
to be	Other names:
protected
Applicant	The applicant is:  ! person seeking to be protected

[If not the	!	parent or guardian of a child who is seeking to be protected
person seeking	!	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	! a Violence Restraining Order	! a Misconduct Restraining Order
Grounds for application
Hearing	Court:	Date:	Time:
Signature of clerk:

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

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.

26 November 2004	GOVERNMENT GAZETTE, WA	5303
Restraining Orders Amendment Regulations 2004

r. 13

Form 13 — Restraining order — summons

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

Certificate of Service

Person	Name of person serving summons:
serving	I am ! the clerk of the court

summons ! a police officer Rank, number and station: ____________________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk Date of authorisation: _______________________

Details of	Method of service: ! personal	! by post	! substituted service
service	Place where summons served:

Date of service:  Time of service:

Person served	Name: Date of birth:
[If possible to
obtain]	Signature:
Certificate	I certify that on the day and at the time and place set out above: ! I posted this summons to the respondent ! I personally served this summons on the respondent

!	I took the steps directed by the court to effect substituted service of this summons on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997.
Signature:	Date:

OR

Summons not	Name of person attempting to serve summons:
served	I am ! the clerk of the court

! a police officer Rank, number and station: ____________________________

!	a prison officer Prison: ____________________________________________
!	a person authorised by the clerk 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 respondent does not appear to live or work at the addresses given and cannot be found elsewhere
!	the respondent 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.

5304 GOVERNMENT GAZETTE, WA 26 November 2004

Restraining Orders Amendment Regulations 2004

r. 13

Form 14 — Application to have decision under section 42 of the Act set aside

Restraining Orders Act 1997 Section 43A.

Number:

Application to set aside

decision under section 42 of Jurisdiction:

the Restraining Orders

Act 1997 Location:

Applicant’s	Name:	Date of birth:
details
Address:

Phone nos.:  work: home: mobile

Respondent’s	Name:
details Date of decision
Date of	" This application is made within 21 days from the date that I first became aware of/ was served with a
application	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 and date

Notice of court

Court:

hearing

Address:
Date and time of hearing:

”.

26 November 2004	GOVERNMENT GAZETTE, WA	5305
Restraining Orders Amendment Regulations 2004

r. 13

By Command of the Governor,

M. C. WAUCHOPE, Clerk of the Executive Council.

———————————

!200400198GG!