Form 5	Warrant—breach of good behaviour obligations etc
Crimes (Sentence Administration) Act 2005
(see s 104 (Arrest warrant—breach of good behaviour obligations etc))
In the *[Supreme/Magistrates] Court of the Australian Capital Territory
Criminal jurisdiction

No *[SCC/CC]			of (year)		

Authority and directions
To*[(insert name of police officer)/the police officers of the ACT]:
You are authorised and directed to arrest the person named in this warrant (the offender) and as soon as practicable bring the offender before the sentencing court, or if the sentencing court is not sitting––a Magistrate.

Details of offender
Name of offender:
Address:

Reason for arrest
I am satisfied by information on oath before me that––
*(a)	there are reasonable grounds for suspecting that the offender has breached, or will breach, a good behaviour obligation of the offender; or
*(b)	the offender has failed to comply with—
*(i)	an agreement under the Crimes (Sentence Administration) Act 2005, section 105 (Good behaviour—agreement to attend court) to attend the Court at the time and place mentioned in the agreement; or
*(ii)	a summons under the Crimes (Sentence Administration) Act 2005, section 106 (Good behaviour—summons to attend court) to attend the Court at the time and place mentioned in the summons.
I am satisfied that the summons was properly served on the offender a reasonable time before the time mentioned in the summons for the appearance.

The matter on which the information is based is as follows:
(state briefly the matter on which the information is based)

Date:
*[Judge/Magistrate]: 

*omit if, or whichever is, inapplicable