*District No.

*Dublin Metropolitan District

WHEREAS …………… of ……………… has been detained in the place of detention at ……… within the said district pursuant to the provisions of *subsection (8) *subsection (13) of section 9 of the above mentioned Act, and is before me pursuant to the provisions of *subsection (10)(a) *subsection (13)(b) of section 9 of the above mentioned Act;

AND WHEREAS I am satisfied that the person

*poses a threat to national security or public order in the State,

*has committed a serious non-political crime outside the State,

*has not made reasonable efforts to establish his/her true identity,

*intends to avoid removal from the State in the event of his/her application for asylum being transferred to a convention country pursuant to section 22 of the above mentioned Act,

*intends to leave the State and enter another state without lawful authority,

*without reasonable cause has destroyed his/her identity or travel documents or is in possession of forged identity documents,

IT IS HEREBY ORDERED that …………… be released subject to the following condition(s):-

(I) that he/she resides or remains *in District No …. of the District Court or *in ………….. in the State,

(II) that he/she reports to the Garda Síochána Station at …………… or immigration officer at …………….. at the following times ………….

(III) That he/she surrenders any passport or travel document in his/her possession.

(IV) That …………………..

(here insert any other conditions imposed)

Dated this …… day of …………….. 20…..

_________________________

Judge of the District Court

To ………………………………

of ……………………………...

*Delete words inapplicable