Form 4	Application to amend order
Domestic Violence and Protection Orders Act 2008, s 59
In the Magistrates Court of the Australian Capital Territory

DV/RO/WO ……./………………

APPLICANT			.........................................................................

RESPONDENT		...................................................................

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

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UPON THE GROUNDS THAT:

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…………………………………………………………………………………………………….

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Signature

Dated this ...................................... day of .......................................................... 20…...

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Deputy Registrar