Form 16	Application for declaration of interstate FVO as recognised FVO
Family Violence Act 2016
(see s 144, s 146 and s 147)
In the Magistrates Court of the Australian Capital Territory

FVO ........ / 20........

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

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

	□	I am a protected person under the FVO
	□	I am the applicant for the declaration in relation to the FVO but 		not a protected person under it
	□	I am the respondent to the FVO
(Tick whichever is applicable)

Details of non-local FVO 
Non-local FVO number:..........................
Date of issue:		.......................................... /20........
Issuing authority:	.............................................................(Name of police or court)
Jurisdiction:		..............................................................(State, territory or NZ) 
*If amended, date of amendment	...................../20......... 
by ..........................................................................................(amending court)
in .................................................................................................(jurisdiction)

	□	*The non-local FVO /* A certified copy of the non-local FVO 		is attached 

To the Registrar of the Magistrates Court:

I,.............................................................................................................. (full name),
apply to have the FVO described above declared to be a recognised FVO in the ACT.
*(If you are the applicant or a protected person under a non-local FVO): 
	□	the respondent to the FVO was properly notified of its making 		under the law of the issuing jurisdiction; 
	□	I consent to notice of the declaration of the FVO as a recognised 		FVO being served on the respondent.
(Tick all that are applicable)

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

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

*delete if inapplicable
□ tick if applicable