Western Australia

Restraining Orders Act 1997

Restraining Orders Regulations 1997

Reprint 1: The regulations as at 13 February 2004

Guide for using this reprint

What the reprint includes

Endnotes, Compilation table, and Table of provisions that have not come into operation

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Notes amongst text (italicised and within square brackets)

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Reprint numbering and date

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Reprinted under the Reprints Act 1984 as

at 13 February 2004

Western Australia

Restraining Orders Regulations 1997

CONTENTS

Part 1 — Preliminary

1.Citation1

2.Commencement1

3.Forms1

Part 2 — Firearms

4.Giving up possession of firearms2

5.Dealing with surrendered or seized firearms3

Part 3 — Practice and procedure

6.Record of telephone application4

7.Adjournment of telephone applications4

8.Procedure when restraining order made during bail hearing4

9.Procedure when restraining order made during other proceedings5

10.Service of documents5

10A.Use of closed circuit television or screening arrangements5

Part 4 — Interstate restraining orders

11.Prescribed laws8

12.Application for registration of interstate order8

Schedule 1 — Forms10

Notes

Compilation table70

	Reprinted under the Reprints Act 1984 as
	at 13 February 2004

Western Australia

Restraining Orders Act 1997

Restraining Orders Regulations 1997

Part 1 — Preliminary

1.Citation

These regulations may be cited as the Restraining Orders Regulations 1997 1.

2.Commencement

These regulations come into operation on the day on which the Restraining Orders Act 1997 comes into operation 1.

3.Forms

(1)The forms set out in Schedule 1 are prescribed in relation to the matters specified in those forms.

(2)A reference in these regulations to a Form followed by a designation is a reference to the form so designated in Schedule 1.

(3)It is sufficient compliance with the Act if a form substantially in compliance with the prescribed Form is used.

Part 2 — Firearms

4.Giving up possession of firearms

(1)This regulation applies when a restraining order which requires the person bound by the order to give up possession of a firearm or a firearms licence is served on a restrained person who is in possession of a firearm or a firearms licence.

(2)If the order is personally or orally served on the restrained person by a police officer and at the time the order is served the restrained person is physically in possession of the firearm or firearms licence the restrained person must immediately give the firearm or firearms licence to the police officer.

(3)Subject to subregulation (5), if the order is personally or orally served on the restrained person by a police officer and at the time the order is served the firearm or firearms licence is at a place to which the police officer can reasonably accompany the person, the restrained person must — 

(a)immediately go with the police officer to that place; and

(b)once there, immediately give the firearm or firearms licence to the police officer.

(4)Subject to subregulation (5), in any other case the restrained person must give the firearm or firearms licence to the police officer in charge of the police station nearest to where the firearm or firearms licence is located as soon as is reasonably practicable and in any event within 24 hours of the order being served.

(5)If a firearm in respect of which a restrained person holds a firearms licence is in the actual physical possession of a co‑licensee of that firearm, the restrained person — 

(a)must comply with subregulation (3) or (4), as the case requires, in respect of the firearms licence; but

(b)need not comply with subregulation (3) or (4), as the case requires, in respect of that firearm.

5.Dealing with surrendered or seized firearms

(1)A firearm or firearms licence given to a police officer under section 14 of the Act, or seized under section 15 of the Act, is to be held in safe custody by the Commissioner of Police until — 

(a)the restraining order ceases to be in force;

(b)it is reclaimed by a co‑licensee; or

(c)it may otherwise lawfully be disposed of.

(2)Before returning a firearm or firearms licence the Commissioner of Police must have regard to section 20 of the Firearms Act 1973.

(3)If a firearm which is being held by the Commissioner has not been reclaimed within 1 month after the restraining order ceases to be in force, the Commissioner may regard the restrained person and any co-licensee as an owner who cannot be found for the purposes of section 33 of the Firearms Act 1973.

(4)If a firearms licence which is being held by the Commissioner is not reclaimed within one month after the restraining order ceases to be in force, the Commissioner may regard the restrained person as having requested, under section 20(4) of the Firearms Act 1973, that the firearms licence be cancelled.

(5)Where the Commissioner is holding a firearm under subregulation (1), regulation 11(2) and (3) of the Firearms Regulations 1974 apply.

Part 3 — Practice and procedure

6.Record of telephone application

The written record required to be made under section 21(4) of the Act is to be made in the form of Form 5.

7.Adjournment of telephone applications

(1)If the hearing of a telephone application is adjourned the clerk is to ensure that the adjourned hearing is listed — 

(a)if the respondent is a child, in the Children’s Court; or

(b)otherwise, in a court of petty sessions,

nearest to the applicant’s usual place of residence.

(2)If the court referred to in subregulation (1) is not the court where the magistrate hearing the telephone application is based, the magistrate is to transfer the matter to the court referred to in subregulation (1).

8.Procedure when restraining order made during bail hearing

(1)This regulation applies when a judicial officer sitting other than as a court makes a restraining order under section 63 of the Act in the course of considering a case for bail.

(2)The judicial officer is to — 

(a)make a written record of the proceedings in the form of Form 11; and

(b)cause the record to be forwarded to the court in which the restrained person is bailed to appear.

(3)The judicial officer may cause the record to be forwarded to the court personally, by ordinary prepaid post or by fax.

(4)If the record is forwarded by fax the judicial officer must — 

(a)as soon as practicable, and in any event not later than the end of the next business day, confirm with the court that the record has been received; and

(b)as soon as practicable forward the original record to the court by ordinary prepaid post.

(5)For the purposes of section 10(1) of the Act a reference to the court is to be read as a reference to the court in which the restrained person is bailed to appear.

9.Procedure when restraining order made during other proceedings

(1)This regulation applies to — 

(a)a court of petty sessions;

(b)the Children’s Court when constituted so as not to include a Judge of that court; and

(c)any other court when constituted so as not to include a Judge of that court.

(2)When a court to which this regulation applies makes a restraining order under section 63 of the Act the court is to make a written record of the proceedings in the form of Form 11 cause the record to be placed on the court records.

10.Service of documents

(1)Personal or oral service of a restraining order is to be effected by the clerk, a police officer, a prison officer (as defined in the Prisons Act 1981) or a person authorised by the clerk.

(2)When a document is given by the clerk to a police officer, prison officer or other authorised person for service, the officer or other person is to take all reasonable steps to serve that document in the manner directed by the clerk.

[Regulation 10 amended in Gazette 8 Jan 2002 p. 33.]

10A.Use of closed circuit television or screening arrangements

(1)If a court hearing a matter relating to a restraining order is of the opinion that, if special arrangements are not made, a party to the matter or a witness would be likely — 

(a)to be unable to give evidence, or to give evidence satisfactorily; or

(b)to suffer severe emotional trauma or be unnecessarily intimidated or distressed,

the court may make such arrangements as it thinks fit, using closed circuit television or screens, one‑way glass or other suitable shielding devices, to reduce the likelihood of that circumstance occurring.

(2)When considering whether to make arrangements under subregulation (1) in respect of a person the court may have regard to — 

(a)the person’s age;

(b)the person’s cultural background;

(c)any physical disability or mental impairment (as defined in the Criminal Law (Mentally Impaired Defendants) Act 1996) of the person;

(d)the relationship of the person to any other person involved in the proceedings;

(e)the effect on the person of the presence of another person;

(f)the nature of the subject‑matter of the proceedings; and

(g)the expressed views of the person;

(h)any other factor the court considers relevant.

(3)When making arrangements under subregulation (1) the court must ensure that — 

(a)the judicial officer and all parties to the matter (or their counsel, if any) are able to see, hear and speak to each witness while he or she is giving evidence;

(b)each party to the matter has the means of communicating with his or her counsel at all times; and

(c)if a person takes part in the proceedings from outside the court room the person is able to see, hear and speak to the judicial officer at all times.

(4)The court may make arrangements under subregulation (1) — 

(a)on the application of a party to the matter, at the request of a witness, or of its own motion; and

(b)at any stage of proceedings.

(5)Whenever a matter relating to a violence restraining order comes before a court, the court must consider whether it ought to make arrangements under subregulation (1).

(6)If a court considers that arrangements ought to be made under subregulation (1) but the necessary facilities are not available, the court may transfer the matter to another court where those facilities are available if to do so is practicable and will not unfairly prejudice any party to the matter.

[Regulation 10A inserted in Gazette 27 Mar 1998 p. 1714.]

Part 4 — Interstate restraining orders

11.Prescribed laws

For the purposes of the definition of interstate order in section 74 of the Act the following laws are prescribed in respect of the following States and Territories — 

(a) Victoria  — Crimes (Family Violence) Act 1987, section 4;

(b) New South Wales  — Crimes Act 1900, section 562B;

(c) South Australia  — 

Summary Procedure Act 1921, Division 7 of Part 4; and

Domestic Violence Act 1994, section 4;

(d) Tasmania  — Justices Act 1959, section 106B;

(e) Queensland  — 

Domestic Violence (Family Protection) Act 1989, Division 1 of Part 2;

Peace and Good Behaviour Act 1982, section 4;

(f) Northern Territory  — Domestic Violence Act 1992, section 4;

(g) Australian Capital Territory  — 

Magistrates Courts Act 1930 sections 197 and 206C; and Domestic Violence Act 1986, sections 4 and 14.

12.Application for registration of interstate order

An application for registration of an interstate order is to be made in the form of the Form 12 and is to be accompanied by — 

(a)the original interstate order or a copy certified to be a true copy by an officer of the court in which it was made; and

(b)such evidence of effective service of the interstate order on the person bound by it as the clerk considers appropriate.

Schedule 1

Forms

[Reg. 3]

Forms for the Restraining Orders Act 1997

Form	Title	Section
1	Violence restraining order — Application Court Copy (front and back) Applicant’s Copy	25(2)
2	Misconduct restraining order — Application Court Copy (front and back) Applicant’s Copy	38(2)
3	Details of family order — Annexure to application Court Copy Applicant’s Copy	66
4	Restraining order — Summons Court Copy Respondent’s Copy Proof of Service Copy (front and back)	26(3) and 39
5	Restraining order — Record of telephone application Magistrate’s Copy (front and back)	21(4)
6	Violence Restraining Order Court Copy Respondent’s Copy (front and back) Respondent’s Endorsement Copy (front and back) Applicant’s Copy (front and back) Police Copy (front and back) Proof of Service Copy (front and back)	29, 32, 43, 49 and 63
7	Telephone Violence Restraining Order Court Copy Respondent’s Copy (front and back) Respondent’s Endorsement Copy (front and back) Applicant’s Copy (front and back) Police Copy (front and back) Proof of Service Copy (front and back)	23
8	Misconduct Restraining Order Court Copy Respondent’s Copy (front and back) Applicant’s Copy (front and back) Police Copy (front and back) Proof of Service Copy (front and back)	43, 49 and 63
9	Restraining order — Application to vary or cancel Court Copy (front and back) Copy for Person Applying to Vary or Cancel (front and back)	45(2)
10	Restraining order — Summons to vary or cancel Court Copy Summonsed Person’s Copy Proof of Service Copy (front and back)	47(1) and (2)
11	Restraining order made during other proceedings — Record of proceedings Court Copy	63
12	Interstate restraining Order — Application to register Court Copy Applicant for Registration’s Copy Police Copy Interstate Court’s Copy	75(2)

Restraining Orders Act 1997 s. 25(2) Violence restraining order Application		Number:
		Jurisdiction: r Court of Petty Sessionsr Children’s Court
		Location:
Person to be protected	Family name:				Date of birth:
	Other names:
	Address:street:
	suburb:postcode:
	Phone nos.:work:home:
Applicant [If you, the applicant, are the person to be protected, you do not need to fill in these details]	Are you:rthe person to be protectedrthe parent or guardian of a child who is to be protected ra police officerrthe legal guardian of the person who is to be protected
	Family name:						Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Respondent [Fill in as many details as you can.]	Family name:					Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:workhome:
Grounds for application	Why do you need a violence restraining order? Because the respondent is likely to: rcommit a violent personal offence against the person to be protected rbehave in a manner that causes the protected person or the applicant to fear that the respondent will commit a violent personal offence against the protected person Give details of the respondent’s behaviour
Family orders [If yes, see the Details of family order Annexure.]	Are there any current family orders relating to the respondent’s rights in relation to children who may be affected by a restraining order?			r Yes r No r Unknown
	Are there any current Family Court proceedings in which such orders are being sought?			r Yes r No r Unknown
Firearms	Does the respondent have a firearm or firearms licence?			r Yes r No r Unknown
	Does the respondent have access to a firearm at work?			r Yes r No r Unknown
First hearing	Do you want the respondent to be present at the first hearing?			r Yes r No
Applicant	Signature:					Date:
Hearing [To by filled in by the court.]	Court:		Date:			Time:
	Signature of clerk:
Notification [To be filled in by the court]	I certify that on __ __/__ __/__ __ __ __ at _______ am/pm at ____________________________________ I notified the applicant of the hearing date. Signature of clerk:

Court Copy

Record of Proceedings
Date	Attendance		Representation		Adjournments
	Applicant	Respondent	Applicant	Respondent
Orders
_____________________________________________________________________________________ Judicial OfficerDateTime
Clerk’s record

Back of Court Copy

Restraining Orders Act 1997 s. 25(2) Violence restraining order Application			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			Location:
Person to be protected	Family name:					Date of birth:
	Other names:
	Address:street:
	suburb:postcode:
	Phone nos.:work:home:
Applicant	Are you:rthe person to be protectedrthe parent or guardian of a child who is to be protected ra police officerrthe legal guardian of the person who is 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:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Grounds for application	Why do you need a violence restraining order? Because the respondent is likely to: rcommit a violent personal offence against the person to be protected rbehave in a manner that causes the protected person or the applicant to fear that the respondent will commit a violent personal offence against the protected person Give details of the respondent’s behaviour
Family orders	Are there any current family orders relating to the respondent’s rights in relation to children who may be affected by a restraining order?				r Yes r No r Unknown
	Are there any current Family Court proceedings in which such orders are being sought?				r Yes r No r Unknown
Firearms	Does the respondent have a firearm or firearms licence?				r Yes r No r Unknown
	Does the respondent have access to a firearm at work?				r Yes r No r Unknown
First hearing	Do you want the respondent to be present at the first hearing?				r Yes r No
Applicant	Signature:						Date:
Hearing	Court:			Date:			Time:
	Signature of clerk:
	Where to attend courtWhen to attend court
If you do not attend the hearing, your application may be dismissed.
	Applicant’s Copy

Restraining Orders Act 1997 s. 38(2) Misconduct restraining order Application		Number:
		Jurisdiction: r Court of Petty Sessionsr Children’s Court
		Location:
Person to be protected	Family name:				Date of birth:
	Other names:
	Address:street:
	suburb:postcode:
	Phone nos.:work:home:
Applicant [If you, the applicant, are the person to be protected, you do not need to fill in these details]	Are you:rthe person to be protectedrthe parent or guardian of a child who is to be protected ra police officerrthe legal guardian of the person who is to be protected
	Family name:						Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Respondent [Fill in as many details as you can.]	Family name:					Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Grounds for application	Why do you need a misconduct restraining order? Because the respondent is likely to: rbehave in a manner that is intimidating or offensive to the protected person rdamage property owned by, or in the possession of, the protected person rbehave in a manner that is, or is likely to lead to, a breach of the peace Give details of the respondent’s behaviour
Family orders [If yes, see the Details of family order Annexure.]	Are there any current family orders relating to the respondent’s rights in relation to children who may be affected by a restraining order?			r Yes r No r Unknown
	Are there any current Family Court proceedings in which such orders are being sought?			r Yes r No r Unknown
Firearms	Does the respondent have a firearm or firearms licence?			r Yes r No r Unknown
	Does the respondent have access to a firearm at work?			r Yes r No r Unknown
Applicant	Signature:					Date:
Hearing [To by filled in by the court.]	Court:		Date:			Time:
	Signature of clerk:
Notification [To be filled in by the court]	I certify that on __ __/__ __/__ __ __ __ at _______ am/pm at ____________________________________ I notified the applicant of the hearing date. Signature of clerk:

Court Copy

Record of Proceedings
Date	Attendance		Representation		Adjournments
	Applicant	Respondent	Applicant	Respondent
Orders
_____________________________________________________________________________________ Judicial OfficerDateTime
Clerk’s record

Back of Court Copy

Restraining Orders Act 1997 s. 25(2) Misconduct restraining order Application			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			Location:
Person to be protected	Family name:					Date of birth:
	Other names:
	Address:street:
	suburb:postcode:
	Phone nos.:work:home:
Applicant	Are you:rthe person to be protectedrthe parent or guardian of a child who is to be protected ra police officerrthe legal guardian of the person who is 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:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Grounds for application	Why do you need a violence restraining order? Because the respondent is likely to: rbehave in a manner that is intimidating or offensive to the protected person rdamage property owned by, or in the possession or, the protected person rbehave in a manner that is, or is likely to lead to, a breach of the peace Give details of the respondent’s behaviour
Family orders	Are there any current family orders relating to the respondent’s rights in relation to children who may be affected by a restraining order?				r Yes r No r Unknown
	Are there any current Family Court proceedings in which such orders are being sought?				r Yes r No r Unknown
Firearms	Does the respondent have a firearm or firearms licence?				r Yes r No r Unknown
	Does the respondent have access to a firearm at work?				r Yes r No r Unknown
Applicant	Signature:						Date:
Hearing	Court:			Date:			Time:
	Signature of clerk:
	Where to attend courtWhen to attend court
If you do not attend the hearing, your application may be dismissed.
	Applicant’s Copy

Restraining Orders Act 1997 s. 66 Details of family order Annexure to application		Number:
		Jurisdiction: r Court of Petty Sessionsr Children’s Court
		Location:
Parties to the family order or proceedings	Name:
	Address:street: suburb:postcode:
	Name:
	Address:street: suburb:postcode:
Children	Names: 1. 2. 3. 4.
	Address:street: suburb:postcode:
Current family order	Date order was made:		Family Court matter no.:
	Court by which order was made:
	Terms of family order which relate to the respondent’s rights in relation to children: [If the person 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 to be protected) is aware of them.]
Current proceedings for family order	Court:		Family Court matter no.:
	Terms of family order being sought which relate to the respondent’s rights in relation to children:
	Are these terms of the order being opposed?r Yesr Nor Unknown
Applicant	Signature:			Date:

Court Copy

Restraining Orders Act 1997 s. 66 Details of family order Annexure to application		Number:
		Jurisdiction: r Court of Petty Sessionsr Children’s Court
		Location:
Parties to the family order or proceedings	Name:
	Address:street: suburb:postcode:
	Name:
	Address:street: suburb:postcode:
Children	Names: 1. 2. 3. 4.
	Address:street: suburb:postcode:
Current family order	Date order was made:		Family Court matter no.:
	Court by which order was made:
	Terms of family order which relate to the respondent’s rights in relation to children: [If the person 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 to be protected) is aware of them.]
Current proceedings for family order	Court:		Family Court matter no.:
	Terms of family order being sought which relate to the respondent’s rights in relation to children:
	Are these terms of the order being opposed?r Yesr Nor Unknown
Applicant	Signature:			Date:

Applicant’s Copy

Restraining Orders Act 1997 s. 26(3) and 39 Restraining order Summons			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			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:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Person to be protected	Family name:
	Other names:
Applicant	The applicant is:r person to be protected r parent or guardian of a child who is to be protected r a police officerr the legal guardian of the person who is to be protected
	Family name:
	Other names:
Type of order	The application is forr a Violence Restraining Orderr 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 absence.

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

A restraining order may also prohibit you from being in possession of a firearm or a firearms licence.

Court Copy

Restraining Orders Act 1997 s. 26(3) and 39 Restraining order Summons			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			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:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Person to be protected	Family name:
	Other names:
Applicant	The applicant is:r person to be protected r parent or guardian of a child who is to be protected r a police officerr the legal guardian of the person who is to be protected
	Family name:
	Other names:
Type of order	The application is forr a Violence Restraining Orderr a Misconduct Restraining Order
Grounds for application
Hearing		Court:		Date:	Time:
		Signature of clerk:
		Where to attend courtWhen to attend court

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

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

A restraining order may also prohibit you from being in possession of a firearm or a firearms licence.

Respondent’s Copy

Restraining Orders Act 1997 s. 26(3) and 39 Restraining order Summons			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			Location:
Respondent Person to be served	Family name:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Person to be protected	Family name:
	Other names:
Applicant	The applicant is:r person to be protected r parent or guardian of a child who is to be protected r a police officerr the legal guardian of the person who is to be protected
	Family name:
	Other names:
Type of order	The application is forr a Violence Restraining Orderr a Misconduct Restraining Order
Grounds for application
Hearing		Court:		Date:	Time:
		Signature of clerk:

Proof of Service Copy

Certificate of Service
Person serving summons	Name of person serving summons:
	I amrthe clerk of the court ra police officer Rank, number and station: ____________________________ ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation: _______________________
Service	Method of service:  r personalr by postr substituted service
	Place where summons served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above:   r I personally served this summons on the respondent   r I posted this summons to the respondent   r 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 served	Name of person attempting to serve summons:
	I amrthe clerk of the court ra police officer Rank, number and station: ____________________________ ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation: _______________________
	Attempted method of service:  r personalr by postr substituted service
	Steps taken to attempt service:
	I was unable to serve this summons because::   r the respondent does not appear to live or work at the addresses given and cannot be found     elsewhere   r the respondent appears to be deliberately avoiding being served with this summons   r 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.

Back of Proof of Service Copy

Restraining Orders Act 1997 s. 21(4) Restraining order Record of telephone application		Number:
		Jurisdiction: Court of Petty Sessions
		Location:
Authorised person	Name:
	Rank and number/identification:
	Contact phone no:		Date of application:
Reason for applying by telephone
	Ir amr am not satisfied that the matter is sufficiently urgent to justify a telephone application.
Person to be protected	Family name:				Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:   work:home:
Applicant [If not the person to be protected]	The applicant is:r person to be protected r parent or guardian of a child who is to be protected r authorised personr legal guardian of the person who is 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:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:  work:home:
	The respondentr isr is not  present r isr is not  being detained by a police officer
Grounds for application
Family orders	Are there any current family orders relating to the respondent’s rights in relation to children who may be affected by a restraining order?r  Yesr  Nor  Unknown
	Are there any current Family Court proceedings in which such orders are being sought?r  Yesr  Nor  Unknown
	Details of family order or proceedings
Firearms	Does the respondent have a firearm or a firearms licence?r  Yesr  Nor  Unknown
	Does the respondent have access to a firearm at work?r  Yesr  Nor  Unknown

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

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of Birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Court Copy

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of Birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of Birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Respondent’s Copy

IMPORTANT INFORMATION

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. 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 the order you may be arrested and will face a penalty of up to $2,000 or imprisonment for 6 months.

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 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.

Because the order was made without you being in court 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 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.

Penalty: It is an offence to breach a violence restraining order. If you breach this interim order you may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

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 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 was served on you; 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, there is a substantial change in the circumstances which led to the order being made you may apply to the court 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 you breach this final order you may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

Back of Respondent’s Copy

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Respondent’s Endorsement Copy

IMPORTANT INFORMATION

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.

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.

Objection
Family name:	Date of birth:
Other names:
Address:street: suburb:postcode:
Will you be represented by a lawyer at the final order hearing?r  Yesr  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?r  Yesr  No • having contact with your children?r  Yesr  No • going to where you work or otherwise prevent you from doing your job?r  Yesr  No • being in possession of a firearm which is essential for your job?r  Yesr  No
Signature:Date:

OR

Consent
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:

Back of Respondent’s Endorsement Copy

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Applicant’s Copy

IMPORTANT INFORMATION

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 respondent. The respondent 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 respondent breaches the order he or she may be arrested and will face a penalty of up to $2,000 or imprisonment for 6 months.

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 respondent and it will remain in force until a final order is made or a court decides not to make a final order. The respondent must comply with this order at all times while it is in force.

Because the order was made without the respondent being in court he or she has 21 days within which to object to the order before it becomes a final order.

If the respondent does object you will need to attend a final order hearing. At that hearing the court will consider anything you and the respondent 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 respondent does object, this interim order will remain in force until the final order hearing.

If the respondent 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 respondent. You will then not need to attend a final order hearing.

Penalty: It is an offence to breach a violence restraining order. If the respondent breaches this interim order he or she may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

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 respondent and it will remain in force until it expires or is varied or cancelled by a court. The respondent 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 was served on the respondent;

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

If, in the future, your want the order varied or cancelled you may apply to the court. The respondent may also apply to have the order varied or cancelled but only if the court is satisfied that there has been a substantial change in the circumstances which led to the order being made. 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 respondent breaches this final order he or she may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

Back of Applicant’s Copy

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Police Copy (for Central Warrant Bureau)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Police Copy

Restraining Orders Act 1997 s. 29, 32, 43, 49 and 63 Violence Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person Person to be served	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim orderr a final order
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Proof of Service Copy (to be returned to court)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officerRank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above:   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Proof of Service Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:
Confirmation by Magistrate		This order r is correctr is not correct and is to be amended as shown above
		Signature:					Date:

Court Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:

Respondent’s Copy

IMPORTANT INFORMATION

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 you. 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 the order you may be arrested and will face a penalty of up to $2,000 or imprisonment for 6 months

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. The order will remain in force for 3 months, unless before then 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.

Because the order was made without you being in court 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 than 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 3 months, or any shorter period specified in the order, 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.

Penalty: It is an offence to breach a violence restraining order. If you breach this interim order you may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

Back of Respondent’s Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:

Respondent’s Endorsement Copy

IMPORTANT INFORMATION

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.

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.

Objection
Family name:	Date of birth:
Other names:
Address:street: suburb:postcode:
Will you be represented by a lawyer at the final order hearing?r  Yesr  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?r  Yesr  No • having contact with your children?r  Yesr  No • going to where you work or otherwise prevent you from doing your job?r  Yesr  No • being in possession of a firearm which is essential for your job?r  Yesr  No
Signature:Date:

OR

Consent
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 3 months, or any shorter time specified in the order, from the date on which this interim order was served on me.
Signature:Date:

Back of Respondent’s Endorsement Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:

Applicant’s Copy

IMPORTANT INFORMATION

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 respondent. The respondent 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 respondent breaches the order he or she may be arrested and will face a penalty of up to $2,000 or imprisonment for 6 months

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 respondent. The order will remain in force for 3 months, unless before then a final order is made or a court decides not to make a final order. The respondent must comply with this order at all times while it is in force.

Because the order was made without the respondent being in court he or she has 21 days within which to object to the order before it becomes a final order

If the respondent does object you will need to attend a final order hearing. At that hearing the court will consider anything you and the respondent want to say before deciding whether to make a 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 respondent does object, this interim order will remain in force for 3 months (or any shorter period specified in the order) or until the final order hearing if that is first.

If the respondent does not object this order will automatically become a final order which remains in force for 3 months, or any shorter period specified in the order, from the date this interim order was served on the respondent or any shorter period specified in the 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 respondent breaches this interim order he or she may be arrested and will face a penalty of up to $6,000 or imprisonment for 18 months.

Back of Applicant’s Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:

Police Copy (for Central Warrant Bureau)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Police Copy

Restraining Orders Act 1997 s. 23 Telephone Violence Restraining Order			Number:
			Jurisdiction where order is registered r Court of Petty Sessionsr Children’s Court
			Location:
Restrained person Person to be served	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Type of order	The order isr for 72 hours or lessr an interim order
Terms of the order
Order made		Date order made:		Time order made:
Authorised person		Name:
		Rank and number/identification:
		Signature:					Date:

Proof of Service Copy (to be returned to court)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above:   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Proof of Service Copy

Restraining Orders Act 1997 s. 43, 49 and 63 Misconduct Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ______________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Court Copy

Restraining Orders Act 1997 s. 43, 49 and 63 Misconduct Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Respondent’s Copy

IMPORTANT INFORMATION

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 came into force when it was served on you 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 was served on you.

If, in the future, there is a substantial change in the circumstances which led to the order being made you may apply to the court 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 misconduct restraining order. If you breach this order you may be arrested and will face a penalty of up to $1,000.

Back of Respondent’s Copy

Restraining Orders Act 1997 s. 43, 49 and 63 Misconduct Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Applicant’s Copy

IMPORTANT INFORMATION

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 will come into force when it is served on the respondent and it will remain in force until it expires or is varied or cancelled by a court. The respondent 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 is served on the respondent.

If, in the future, you want the order varied or cancelled you may apply to the court. The respondent may also apply to have the order varied or cancelled but only if the court is satisfied that there has been a substantial change in the circumstances which led to the order being made. 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 misconduct restraining order. If the respondent breaches this order he or she may be arrested and will face a penalty of up to $1,000.

Back of Applicant’s Copy

Restraining Orders Act 1997 s. 43, 49 and 63 Misconduct Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Police Copy (for Central Warrant Bureau)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Police Copy

Restraining Orders Act 1997 s. 43, 49 and 63 Misconduct Restraining Order			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court r Other: ___________________________________
			Location:
Restrained person Person to be served	Family name:				Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Protected person	Family name:					Date of birth:
	Other names:
Terms of the order
Order made		Date order made:		Time order made:
Clerk		Signature:					Date:

Proof of Service Copy (to be returned to court)

Certificate of Service
Person serving order	Name of person serving order:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr oralr by postr substituted service
	Place where order served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above:   r I personally served this order on the respondent   r I orally served this order on the respondent   r I posted this order to the respondent   r I took the steps directed by the court to effect substituted service of this order on the respondent in accordance with Division 2 of Part 6 of the Restraining Orders Act 1997, and in the case of oral service I also certify that the respondent appeared to understand what was said.
	Signature:		Date:

Back of Proof of Service Copy

Restraining Orders Act 1997 s. 45 Restraining order Application to vary or cancel				Number:
				Jurisdiction: r Court of Petty Sessionsr Children’s Court
				Location:
Person applying to vary or cancel	Family name:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person r the restrained person
Restraining order	Type of order: r Violence Restraining Orderr Misconduct Restraining Order
	Date order was made:				Restraining Order no:
	Restrained person:
	Protected person:
Substantial changes [Only fill this in if the application is being made by the restrained person]	If you are the restrained person, what circumstances have substantially changed since the order was made?
Variation or cancellation		Do you want the order to ber cancelledr amended If amended, what do you want changed?
Grounds for variation or cancellation		Why do you want the restraining order varied or cancelled?
Hearing [To be filled in by the court]		Court:				Date:	Time:
		Signature of clerk:
Notification [To be filled in by the court]			I certify that on __ __/__ __/__ __ __ __ at _____ am/pm at I notified the person applying to vary or cancel of the hearing date. Signature of clerk:

Court Copy

Record of Proceedings
Date	Attendance		Representation		Adjournments
	Applicant	Respondent	Applicant	Respondent
Orders
___________________________________ ________________ __________________ Judicial Officer Date Time
Clerk’s record

Back of Court Copy

Restraining Orders Act 1997 s. 45 Restraining order Application to vary or cancel			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			Location:
Person applying to vary or cancel	Family name:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person r the restrained person
Restraining order	Type of order: r Violence Restraining Orderr Misconduct Restraining Order
	Date order was made:			Restraining Order no:
	Restrained person:
	Protected person:
Substantial changes	If you are the restrained person, what circumstances have substantially changed since the order was made?
Variation or cancellation		Do you want the order to ber cancelledr amended If amended, what do you want changed?
Grounds for variation or cancellation		Why do you want the restraining order varied or cancelled?
Hearing		Court:			Date:	Time:
		Signature of clerk:
Where to attend courtWhen to attend court

Copy for Person Applying to Vary or Cancel

IMPORTANT INFORMATION

Application by the protected person

If you are the protected person (or someone acting on behalf of the protected person) 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 court will summons the respondent 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 restrained person

If you are the restrained person 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 protected person will not attend this hearing. At this hearing you will have the opportunity to convince the court that there has been a substantial change in the relevant circumstances since the restraining order was made.

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

If the court is not satisfied that there has been a substantial change of circumstances your application to vary or cancel the restraining order will be dismissed.

If the court is satisfied that there has been a substantial change of circumstances the court will set a date for a further hearing and will summons the protected person (or a person acting on behalf of the protected person) to attend. At that hearing the court will decide whether or not to vary or cancel the restraining order.

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

Back of Copy for Person Applying to Vary or Cancel

Restraining Orders Act 1997 s. 47 Restraining order Summons to vary or cancel			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			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 summonsed	r Protected personr Parent or guardian of a protected child r Restrained Personr Legal guardian of the protected person
	Family name:					Date of birth:
	Other names:
	Home street: address:suburb:postcode:
	Work street: address:suburb:postcode:
	Phone nos.:work:home:
Restraining order	r Violence Restraining Order r Misconduct Restraining Order			Date order made:
				Date order served:
	Restrained person:
	Protected person:
Application	An application has been made for the restraining order to be: r cancelled r amended The amendments sought are as follows:
Grounds for application
Applicant		Signature:					Date:
Hearing [To be filled in by the court]		Court:			Date:		Time:
		Signature of clerk:

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

Court Copy

Restraining Orders Act 1997 s. 47 Restraining order Summons to vary or cancel				Number:
				Jurisdiction: r Court of Petty Sessionsr Children’s Court
				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 summonsed		r Protected personr Parent or guardian of a protected child r Restrained Personr Legal guardian of the protected person
		Family name:					Date of birth:
		Other names:
		Home street: address:suburb:postcode:
		Work street: address:suburb:postcode:
		Phone nos.:work:home:
Restraining order		r Violence Restraining Order r Misconduct Restraining Order			Date order made:
					Date order served:
		Restrained person:
		Protected person:
Application		An application has been made for the restraining order to be: r cancelled r amended The amendments sought are as follows:
Grounds for application
Applicant			Signature:					Date:
Hearing			Court:			Date:		Time:
			Signature of clerk:
	Where to attend courtWhen to attend court

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

Summonsed Person’s Copy

Restraining Orders Act 1997 s. 47 Restraining order Summons to vary or cancel			Number:
			Jurisdiction: r Court of Petty Sessionsr Children’s Court
			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 summonsed Person to be served	r Protected personr Parent or guardian of a protected child r Restrained Personr Legal guardian of the protected person
	Family name:					Date of birth:
	Other names:
	Home street: address:suburb:postcode:
	Work street: address:suburb:postcode:
	Phone nos.:work:home:
Restraining order	r Violence Restraining Order r Misconduct Restraining Order			Date order made:
				Date order served:
	Restrained person:
	Protected person:
Application	An application has been made for the restraining order to be: r cancelled r amended The amendments sought are as follows:
Grounds for application
Applicant		Signature:					Date:
Hearing		Court:			Date:		Time:
		Signature of clerk:

Proof of Service Copy

Certificate of Service
Person serving summons	Name of person serving summons:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: ____________________________________________ ra person authorised by the clerk  Date of authorisation:
Service	Method of service:  r personalr by postr substituted service
	Place where summons served:
	Date of service:	Time of service:
Person served [If possible to obtain]	Name:
	Date of birth:
	Signature:
Certificate	I certify that on the day and at the time and place set out above:   r I personally served this summons on the respondent   r I posted this summons to the respondent   r 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 served	Name of person attempting to serve summons:
	I amrthe clerk of the court ra police officer Rank, number and station: ra prison officerPrison: _____________________________________________ ra person authorised by the clerk  Date of authorisation:
	Attempted method of service:  r personalr by postr substituted service
	Steps taken to attempt service:
	I was unable to serve this summons because:   r the respondent does not appear to live or work at the addresses given and cannot be found     elsewhere   r the respondent appears to be deliberately avoiding being served with this summons   r 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.

Back of Proof of Service Copy

Restraining Orders Act 1997 s. 63 Restraining order made during other proceedings Record of proceedings		Number:
		Jurisdiction: r Court of Petty Sessionsr Children’s Court
		Location:
Application	Order made:r by Court of its own motionr on an application or request by
Person to be protected	Family name		Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
	Role in proceeding in which restraining order was made:  r applicant/complainantr respondent/defendant  r other witnessr other
Person to be restrained	Family name:			Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:workhome:
	Role in proceeding in which restraining order was made:  r applicant/complainantr respondent/defendant  r other witnessr other_______________________________________________
Grounds on which order applied for or considered
Family orders	Are there any current family orders relating to the respondent’s rightsr Yesr No in relation to children who may be affected by a restraining order?
	Are there any current Family Court proceedings in which suchr Yesr No orders are being sought?
	Details of family order or proceedings
Firearms	Does the person to be restrained have a firearm or a firearms licence?r Yesr No
	Does the person to be restrained have access to a firearm at work?r Yesr No
Witness and summary of evidence	Person to be protected: Person to be restrained:
	Other people:

Other notes
Terms of the order
Order made	Date order made:	Time order made:
Clerk	Signature:		Date:

Court Copy

Restraining Orders Act 1997 s. 75 Interstate restraining order Application to register				Number:
				Jurisdiction:Court of Petty Sessions
				Location:
Protected person	Family name:						Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Applicant [If you, the applicant, are the protected person, you do not need to fill in these details]	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person
	Family name:						Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Restrained person [Fill in as many details as you can]	Family name:							Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb: postcode:
	Phone nos.:work:home:
Interstate order		State where order was made:
		Court in which order was made:
		Date order was made:			Order/matter no.:
Notice		Ir dor do not  want notice of the registration of this order given to the restrained person.
Applicant		Signature:							Date:
Registered [To be filled in by the court]		Date of registration:				Time of registration:
		Signature of clerk:				Date:
Notification [To be filled in by the court]			I certify that on __ __/__ __/__ __ __ __ at ______ am/pm at I notified the applicant that the order had been registered. 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 restrained person.

Court Copy

Restraining Orders Act 1997 s. 75 Interstate restraining order Application to register			Number:
			Jurisdiction:Court of Petty Sessions
			Location:
Protected person	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Applicant	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person
	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Restrained person	Family name:						Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Interstate order		State where order was made:
		Court in which order was made:
		Date order was made:		Order/matter no.:
Notice		Ir dor do not  want notice of the registration of this order given to the restrained person.
Applicant		Signature:						Date:
Registered		Date of registration:			Time of registration:
		Signature of clerk:			Date:

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

Applicant for Registration’s Copy

Restraining Orders Act 1997 s. 75 Interstate restraining order Application to register			Number:
			Jurisdiction:Court of Petty Sessions
			Location:
Protected person	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Applicant	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person
	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Restrained person	Family name:						Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Interstate order		State where order was made:
		Court in which order was made:
		Date order was made:		Order/matter no.:
Notice		Ir dor do not  want notice of the registration of this order given to the restrained person.
Applicant		Signature:						Date:
Registered		Date of registration:			Time of registration:
		Signature of clerk:			Date:

Notification to the Commissioner of Police

The interstate restraining order described above has been registered in Western Australia .

A copy of the interstate order is attached.

Police Copy (for Central Warrant Bureau)

Restraining Orders Act 1997 s. 75 Interstate restraining order Application to register			Number:
			Jurisdiction:Court of Petty Sessions
			Location:
Protected person	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Applicant	Are you:r the protected personr the parent or guardian of a protected child r a police officerr the legal guardian of the protected person
	Family name:					Date of birth:
	Other names:
	Address:street: suburb:postcode:
	Phone nos.:work:home:
Restrained person	Family name:						Date of birth:
	Other names:
	Homestreet: address:suburb:postcode:
	Workstreet: address:suburb:postcode:
	Phone nos.:work:home:
Interstate order		State where order was made:
		Court in which order was made:
		Date order was made:		Order/matter no.:
Notice		Ir dor do not  want notice of the registration of this order given to the restrained person.
Applicant		Signature:						Date:
Registered		Date of registration:			Time of registration:
		Signature of clerk:			Date:

Notification to the Registrar or Clerk

The restraining order described above and made in your court has been registered in Western Australia . If the original order is varied or cancelled please notify the clerk of the court mentioned above.

Interstate Court’s Copy

[Schedule 1 (Correction in Gazette 16 Sep 1997 p. 5235); amended in Gazette 8 Jan 2002 p. 33.]

Notes

1This reprint is a compilation as at 13 February 2004 of the Restraining Orders Regulations 1997 and includes the amendments made by the other written laws referred to in the following table. The table also contains information about any reprint.

Compilation table

Citation	Gazettal	Commencement
Restraining Orders Regulations 1997	12 Sep 1997 p. 5079‑146 (correction 16 Sep 19697 p. 5235)	15 Sep 1997 (see r. 2 and Gazette 12 Sep 1997 p. 5149)
Restraining Orders Amendment Regulations 1998	27 Mar 1998 p. 1714	27 Mar 1998
Restraining Orders Amendment Regulations (No. 2) 2001	8 Jan 2002 p. 32‑3	8 Jan 2002
Reprint 1: The Restraining Orders Regulations 1997 as at 13 Feb 2004 (includes amendments listed above)

By Authority: JOHN A. STRIJK, Government Printer