Form 12 – Application for substituted service
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)..........................................................................................................
Apply for an order that:
Pursuant to section 66 of the Domestic Violence and Protection Orders Act 2008, 
service of: …………………………………………………………………………………………
………………………………………………………………………………………………………
Dated …………………………………… be effected as follows:[state method of  
alternative service] : …………………………………………………………………………….
………………………………………………………………………………………………………
………………………………………………………………………………………………………

Attempts at service:
The following attempts to serve the documents have been unsuccessful:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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Applicant’s signature

NOTE:  This application is set down for hearing on the................ day of ........................, 2009 at..................................., at the Magistrates Court at Knowles Place, Canberra.

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

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Deputy Registrar