Form 7	Application to review a special interim family violence order
Family Violence Act 2016
(see s 87)
In the Magistrates Court of the Australian Capital Territory

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

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

I, ..............................................................................................................(full name), the respondent to the special interim family violence order made on .......................................................................(date), seek leave to apply for review of the order in relation to:
	□	the identity of the respondent;
	□	an administrative defect or error in the order;
	□	whether or not there are outstanding related charges in relation
		to the respondent.
(Tick all that are applicable)

I seek an order that:
	□	the order be revoked;
	□	the order be set aside and a new order made in the following
		terms:  
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
(attach additional page if necessary)

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

................................................................................................................................
(Name of applicant or applicant’s solicitor)