Magistrates Court Rules 1932—Form 16
(see s 71)
Security
Australian Capital Territory
[Name in full] the defendant was this day [or on the 		day of			] by a certain conviction of the Magistrates Court at Canberra in the Australian Capital Territory adjudged to pay the sum of		[by instalments of			for every	days the first instalment to be paid on				] and to give security for the due payment of the sum.  Now therefore 				and his or her sureties 
		of			in the Territory and 			of		in the Territory undertake that			will pay the sum adjudged at the time and in way directed and severally acknowledge themselves bound to forfeit and pay to			the sum of		in case			    fails to perform this undertaking.
(Signed) [When not taken orally]
….................................
Defendant
.....................................
Sureties
Taken [orally] before me on 
....................................
Magistrate

Endnotes
1	This form was originally in the Magistrates Court Rules, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the regulations and became a form approved under section 256 of the Magistrates Court Act 1930 (the authorising Act) (see amdt 1.2764, amdt 1.2782).
2	Under the Court Procedures Act 2004 A2004-58, pt 8, this form became a form approved under that Act.
3	This republication includes amendments made under the Legislation Act, part 11.3 (Editorial changes).

©  Australian Capital Territory 2005