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District Court Rules

Schedule: C - Forms in civil proceedings

Form: 59.5 Information - Domestic Violence Acts, 1996 and 2002 section 4
S.I. No. 202 of 2005

No. 59.5


Schedule C
O.59,r.6

Domestic Violence Acts, 1996 and 2002 section 4

Information


District Court Area of

District No.

………… Applicant

………… Respondent

The information of *the above-named applicant of ……..

*(or …… of the ...… Health Board on behalf of the applicant by virtue of section 6 of the above-mentioned Act) who says on oath:-

On the …..day of……………..20…., I caused a summons for hearing at the District Court at …… on the ... day of …… 20…; at …. am./pm. to be issued against the above-named respondent of …………., applying for a barring order in respect of ……….

*(in the Court District aforesaid) being the place where I *and any dependent person reside(s) and I now request an Interim Barring Order against the respondent pursuant to the provisions of section 4 of the above-named Act of 1996 as amended on the grounds:-

…………

and I say that there is an immediate risk of significant harm to me *and *or any dependent person if this order is not made immediately, and the granting of a Protection Order would not be sufficient to protect me *and *or any dependent person.

Dated this ...day of ……, 20….

Signed ………….

Informant

Sworn before me this ...day of ……, 20….

Signed ………………….

Judge of the District Court

To ………… of………………

Respondent.

*Delete where inapplicable