Form 4	Application to amend a family violence order or registered order
Family Violence Act 2016
(see pt 5 or s 200A)	
In the Magistrates Court of the Australian Capital Territory

FVO ........ /........

............................................................................................................(full name)
Applicant
............................................................................................................(full name)
Respondent

Order type: 	Interim / Final / Consent / Registered
(Circle all that are applicable)
	□	I am a protected person under the order

	□	I am the applicant for the order but not a protected person 			under it

	□	I am the respondent to the order
(Tick all that are applicable)

I, ..............................................................................................................(full name), apply to have the order, dated .............................................................................., amended:
*by extending the order in the same terms for the following period:
______ /______ /20______ to ______ /______ /20______.

OR
*as follows:............................................................................................................
................................................................................................................................
................................................................................................................................

*for the period of the order OR *for the following period:
______ /______ /20______ to ______ /______ /20______;  .

This application is made on the following grounds:
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................

...................................................................	Dated: ______ /______ /20______
(Signature of applicant or applicant’s solicitor)

................................................................................................................................
(Name of applicant or applicant’s solicitor)
* Delete whichever is inapplicable