Form 4.9	Supreme Court application for bail by unrepresented accused person
Court Procedures Rules 2006
(see r 4723 (Supreme court application for review of bail by unrepresented accused person)) 
In the Supreme Court of the Australian Capital Territory
Criminal jurisdiction

No		of (year)

In the matter of an application in relation to the grant of bail to (name of accused person)

Take notice that the Court will hear an application by the accused person on (date), at (time) (or as soon after that as this application can be heard), to make the following orders:
1.	That the accused person be granted bail.
2.	Any other orders that the Court considers appropriate.

Grounds of application
1.	My date of birth is (date).
2.	I have made the following applications for bail in the Magistrates Court:
Magistrate who heard application for bail	Date of application	

		
*3.	I applied for bail in the Supreme Court on (date) and Justice (name of judge) refused bail for the following reasons: (state briefly the reasons bail was refused)
4.	I have the following charges outstanding against me:
Charges	Charge number (if known)	

		
		
5.	*Annexed and marked ‘A’ are the charge sheets for the charges.
6.	*Annexed and marked ‘B’ is the statement of facts for the charges.
7.	I *[have/do not have] a criminal record.
8.	I have been in custody since (date).
9.	The matter is next in the *[Supreme Court/Magistrates Court] for *[mention/sentence/trial] on (date).
10.	The police officer in charge of my case is (name of police officer).
11.	*(if the Bail Act 1992, section 9C (Bail for murder and certain serious drug offences), section 9D (Bail for serious offence committed while charge for another pending or outstanding) or section 9E (Bail for person sentenced to imprisonment) applies to the application)  The special or exceptional circumstances in favour of granting bail are:
	(state special or exceptional circumstances).
12.	(this clause MUST be completed if 2 or more bail applications have been made to the Magistrates Court or 1 application has been made to the Supreme Court)  I seek bail for the following reasons:
(a)	the change in circumstances since the court’s last refusal are: (state the change in circumstances)
	OR
(b)	the following fresh evidence or information that was unavailable when the court last refused bail is:
	(state the fresh evidence or information)
14.	I seek bail with the following conditions: (tick box)
□	live at (address)
□	report to the officer in charge of the (name) police station between the hours of (times) on (days)
□	accept supervision
□	enter the residential program at (place) (evidence of acceptance into program to be annexed to this application)
□	not to approach the following people (list people)
15.	□	I want to attend the bail hearing in person. (tick box)
(state the reasons why you want to attend the bail hearing in person)
I declare that every statement in this application is true.
Date:
(signature of accused person)
(name of accused person)

To:	*[Director of Public Prosecutions
	(address for service)

*omit if, or whichever is, inapplicable