Protection Orders Act 2001—Form 5
(see s 16)
Notice of application

Australian Capital Territory

To (applicant’s name)
This application is set down for hearing on the 	day of		
20 	at 	am/pm at the Magistrates Court at	
Dated this 	day of		20	.
[Signature]
Registrar

Endnote
1	Under the Court Procedures Act 2004 A2004-59, pt 8, this form became a form approved under that Act.

©  Australian Capital Territory 2005