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
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