Form 11	Notice of Motion
Domestic Violence and Protection Orders Regulation 2009, s 61
In the Magistrates Court of the Australian Capital Territory

DV/RO/WO ……. /………………

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

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

I, (name)  …………............................................................................................................
Apply  for:

………………………………………………………………………………………………………

………………………………………………………………………………………………………
On the following grounds:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

I rely on the following affidavits in support of my application:

1.	………………………………………. dated ………………………..

2.	………………………………………. dated ………………………..

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Signature

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

NOTE:  This application is set down for the................ day of ........................, 20……. at..................................., at the Magistrates Court at Knowles Place, Canberra.

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Deputy Registrar