Form 4 – Application to amend order
Domestic Violence and Protection Orders Act 2008
In the Magistrates Court of the Australian Capital Territory
DV/RO/WO 09/………………

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Applicant

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Respondent

I, (name of applicant)..........................................................................................................
Pursuant to Part 7 of the Domestic Violence and Protection Orders Act 2008 apply to have the order of the Court dated …………………….................  amended as follows:

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UPON THE GROUNDS THAT:

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Applicant’s signature

Dated this ...................................... day of .......................................................... 2009.

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Deputy Registrar