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District Court Rules

Schedule: C - Forms in civil proceedings

Form: 59.7 Information - Domestic Violence Act, 1996 section 5

No. 59.7

O.59,r.7 (2)

Domestic Violence Act, 1996

section 5

Information


District Court Area of

District No.

........... Applicant

............ Respondent

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

*(in the Court District aforesaid)* (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 ...... 19...., I caused a summons for hearing at ....... District Court on the ... day of .....19.... to be issued against the above-named respondent of ......... applying pursuant to the provisions of *section 2 of the above Act for a safety order *section 3 of the above Act for a barring order in respect of ........... *(in the Court District aforesaid) being the place where I *and any dependent person resides) and I now request a protection order against the respondent pursuant to the

provisions of section 5 of the above Act on the grounds that:-

Dated this ... day of ..... 19..

Signed ....................

Informant

Sworn before me this .... day of ...... 19...

Signed ...........

Judge of the District Court

*Delete where inapplicable