Form 81	Magistrates Court—security
Magistrates Court Act 1930
(see s 249 (Securities taken under Act))
In the Magistrates Court of the Australian Capital Territory
Criminal jurisdiction

No MC		of (year)

*[The Queen/(name of informant)]
and
(name of accused person)

The defendant (name of defendant) was on (date) ordered to pay $ (amount) [by instalments of $ (amount) each (period), starting on (date)] and to give security for the payment of the amount.

The defendant *[and the defendant’s surety] undertake*[s] that the defendant *[and the defendant’s surety] will pay the amount, at the time and in the way, ordered to be paid.

The defendant *[and the defendant’s surety, (name and address of surety)], acknowledge*[s] that the *[defendant/surety] is bound to forfeit and pay to the court $ (amount) if the defendant *[and the defendant’s surety] fail*[s] to perform the undertaking.

*Date:
(signature of defendant)
(signature of surety)

*Taken orally before me on (date)

(signature of magistrate)
Magistrate