Approved form 2001-43

made under the
Magistrates Court Act 1930

Magistrates Court Act 1930—Form 22

The like on a separate paper
WHEREAS AB was, on the                             day of                         , 20     , committed by [me] to the *gaol/remand centre at                                          , in the                                                               , charged with [etc naming the offence shortly]:
I hereby certify that I consent to AB being bailed by recognisance, himself or herself in the sum of                               and [2] sureties in the sum of 
                                [each] (to be included where an order is made under section 248A)
And the withinnamed AB himself or herself in the sum 
of                           to comply with (here insert terms of order under section 248A).
Dated this                                 day of                                , 20     .
	[Signature]
	Magistrate
*Strike out whichever is inapplicable.

Endnote
This form was originally in the Magistrates Court Act 1930 (the authorising Act), schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the authorising Act and became a form approved under section 256 of that Act (see amdts 1.2764 and 1.2769).

Unauthorised version prepared by ACT Parliamentary Counsel's Office

©  Australian Capital Territory 2001