Form 10	Application to review a personal protection consent order, workplace protection consent order or registered consent order
Personal Violence Act 2016
(see pt 6 or s 200A)	
In the Magistrates Court of the Australian Capital Territory

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

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

Order type: 		Consent / Registered
(Circle applicable order)

	□	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:
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(attach additional page if necessary)

□ tick if applicable

	□	That the original order be revoked.

This order is sought for the following reasons:
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*If the original order was induced by fraud or duress:

	□	That the original order be amended in the following terms:
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(attach additional page if necessary)
	□	That the original order be declared void.
This order is sought for the following reasons (include details of the circumstances and full name of people involved in the fraud or duress).
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* Delete if inapplicable
□ tick if applicable

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

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