Form 9	Application to review a personal protection order, workplace protection order or registered order
Personal Violence Act 2016 
(see pt 6 or s 93 (b))
In the Magistrates Court of the Australian Capital Territory

PPO / WPO ......../..............
............................................................................................................(full name)
Applicant
............................................................................................................(full name)
Respondent

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

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

	□	I am the respondent to the original order

	□	Other (please specify your interest in the original order)
(Tick if applicable and for ‘other’ attach details of your interest)
I,...............................................................................................................(full name), apply to have the original order, dated ..............................................................., reviewed, and seek the following orders:

	□	That leave be granted by the Court to bring an application for
		review.  (If applicant for review is respondent to the original order or ‘other’)

	□	That the original order be set aside and replaced with a new 
		order in the following terms:
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
(attach additional page if necessary)
	□	That the original order be revoked.

This order is sought for the following reasons:
................................................................................................................................
................................................................................................................................
................................................................................................................................

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

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

* Delete whichever is inapplicable
□ tick if applicable