Approved Forms (Magistrates Court Criminal Rules 1992)

South Australia
APPROVED FORMS
Approved Forms relating to Magistrates Court Criminal Rules 1992.
INDEX OF FORMS
Form 01
Application for release on bail ....................................................................................................................... 6
Form 06
Application for review of bail by Magistrate ................................................................................................... 7
Form 07
Application to vary or revoke bail .................................................................................................................. 9
Form 7
Application to vary conditions of or revoke bail agreement .......................................................................11
Form 08
Application to vary terms of or revoke guarantee of bail ...........................................................................13
Form 01
Complaint .....................................................................................................................................................15
Form 02
complaint and summons .............................................................................................................................16
Form 03
Complaint and summons with form for plea ...............................................................................................19
Form 04
Information ..................................................................................................................................................23
Form 05
Information and summons ..........................................................................................................................25
Form 05A Summons........................................................................................................................................................28

Form 5B
Summons .....................................................................................................................................................31
Form 06
Warrant of apprehension ..............................................................................................................................34
Form 07
Warrant of remand ......................................................................................................................................36
Form 08
Form of election ...........................................................................................................................................38
Form 9A
Admission and consent t sentence ..............................................................................................................42
Form 10
Order of committal ......................................................................................................................................44
Form 11
Summons to witness ....................................................................................................................................45
Form 12
Warrant to arrest witness ............................................................................................................................49
Form 13
Notice to produce person from custody......................................................................................................53
Form 15
Notice in respect of drivers licence pursuant to section 27c(2) or section 27c(3) ......................................55
Form 15A Summons to person substantially affected...................................................................................................58

Form 16
Notice of order of forfeiture, destruction, compensation etc.....................................................................61
Form 17
Notice of previous convictions.....................................................................................................................64
Form 18
Notice of penalty .........................................................................................................................................66
Form 19
Application for rehearing ...............................................................................................................................67
Form 20
Notice of committal on written plea of guilty .............................................................................................69
Form 21A Important information for defendants committed for trial to the Supreme or District Court (State
Prosecutions) ...........................................................................................................................................70
Form 21B Information for defendants committed for trial (Commonwealth Prosecutions) ........................................73
Form 22
Application to vary a community service order ...........................................................................................76
Form 23
Application miscellaneous statutory jurisdiction section 10 rule 29 Magistrates Court Act ................78
Form 24
Warranty of commitment - contempt .........................................................................................................81
Form 25
Request for registration of order .................................................................................................................83
Form 26
Warrant of distress against body corporate registered order ..................................................................85
Form 27
Authority to enter and inspect section 22 Magistrates Court Act ............................................................88
Form 28
Application for intervention order...............................................................................................................89
Form 28A Complaint (paedophile restraining order) ...................................................................................................... 3

Form 28B Complaint (child protection restraining order) ............................................................................................... 4
Form 29
Interim intervention summons order ............................................................................................................ 6
Form 29A Summons (paedophile restraining order) .....................................................................................................10

Form 29B Summons (child protection restraining order) ..............................................................................................13
Form 30
Intervention order .......................................................................................................................................16
Form 31
Application for variation or revocation of intervention order ....................................................................20
Form 31A Restraining order (paedophile) and summons (s 99A and 99C) ...................................................................21
Form 31B Restraining order (child protection) and summons ......................................................................................25
Form 31C Restraining order (Paedophile) .....................................................................................................................28
Form 31D Restraining order (child protection)..............................................................................................................29
Form 32
Application to revoke restraining order ......................................................................................................30
Form 33
Restraining order as varied ..........................................................................................................................33
Form 34
Order revoking restraining order .................................................................................................................36
Form 35
Notice of not guilty hearing .........................................................................................................................37
Form 36
Problem gambling order ..............................................................................................................................40
Form 37
Notice of problem gambling attachment order ..........................................................................................41
Form 38
Notice of intention to assign tenancy ..........................................................................................................42
Form 39
Tenancy Order .............................................................................................................................................44
Form 40
Application to vary or revoke a problem gambling order or tenancy order ................................................45
Form 41
Request to register foreign intervention order ...........................................................................................46
Form 41
Request to register foreign intervention order ...........................................................................................47
Form 42
Notice of registration of foreign intervention order ...................................................................................48
Form 43
Multilingual notice .......................................................................................................................................49
Form 44
Application for extension of period of detention ........................................................................................52
Form 45
Affidavit (intervention order) ......................................................................................................................53
Form 46
Order for variation or revocation of intervention order .............................................................................55
Form 47
Application for a control order ....................................................................................................................56
Form 48
Interim control order and summons ...........................................................................................................57
Form 49
Control order ...............................................................................................................................................59
Form 50
Application for variation or revocation of
control order or interim control order ................................................
Form 51
Order for variation or revocation of control order or interim control order ..............................................63
Form 53
Application for warrant (Animal Welfare Act) .............................................................................................64
Form 53
Warrant (Animal Welfare Act s.31D) ...........................................................................................................66
Form 54
Duplicate warrant (Animal Welfare Act s.31D)............................................................................................68
Form 55
Appeal of enforcement determination........................................................................................................70
Form 56
Application for community service order ....................................................................................................71
Form 57
Application to revoke community service order ...........................................................................................72
Form 58
Application to oppose seizure and sale of assets ........................................................................................73
Form 59
Order to exclude property from sale or direct proceeds of sale .................................................................74
Form 60
Application to release a seized and clamped or impounded vehicle ..........................................................75
Form 61
Order to release a seized and clamped or impounded vehicle ...................................................................77
Form 62
Notice of community service order (pecuniary penalties) ..........................................................................78
Form 63
Order for restoration of pecuniary ..............................................................................................................79
Form 73
Order for detention mental incapacity provision CLCA ............................................................................80
Form 74
Warrant of apprehension for forensic procedure .......................................................................................81
Form 75
Fortification removal order..........................................................................................................................82
Form 77
Withdrawal notice 9Fortification Removal Order, SOA s.74BH) .................................................................86
Form 77
Withdrawal notice (fortification removal order, SOA s.74BH) ....................................................................88
Form 78
Warrant of arrest (Criminal Law (Sentencing) Act, 1988, s.71(3)(a),71 (4)) ................................................90
Form 79
Application for review of licence disqualification/suspension (Road Traffic Act 1961 s47IAB) ..................91
Form 80
Application for special arrangements (Evidence Act) ..................................................................................92
Form 81
Notice of objection (Evidence Act) ..............................................................................................................93
Form 82
Warrant of arrest fail community service (Criminal law (Sentencing) Act 1988, s71(3)(b)) .....................95
Form 83
Application for clamping, impounding and forfeiture of vehicles ...............................................................97
Form 84
Order to extend clamping period or offer for impounding or forfeiture of motor vehicle .......................100
Form 85
Order for relief (Criminal law (Clamping, Impounding and Forfeiture of Vehicles) Act 2007 ........ s.12(1))
102
Form 86
Application for a warrant to seize a motor vehicle (Criminal Law (Clamping, Impounding and .. Forfeiture
of Vehicles) Act 2007 s.17(2)) ........................................................................................................................................104
Form 87
Warrant of seizure of motor vehicle (Criminal Law Clamping, Impounding and Forfeiture of Vehicles) Act
2007 s.17(2) ...................................................................................................................................................................107
Form 88
Warrant of seizure of motor vehicle [telephone application] (Criminal Law (Clamping, ... Impounding and
Forfeiture of Vehicles) Act 2007 s.17(2)) .......................................................................................................................109
Form 89
Duplicate warrant of seizure of motor vehicle (Criminal Law (Clamping, Impounding and ..... Forfeiture of
Vehicles) Act 2007 s17(2)) .............................................................................................................................................111
Form 90
Application for warrant to enter and search
premises (Road Traffic Act 1961 s.40T and 341B) ...............................
Form 91
Warrant to enter and search premises (Road Traffic Act 1961 s.40T and 41B) ........................................116
Form 92
Duplicate warrant to enter and search premises (Road Traffic (Miscellaneous) Regulations 1999, Reg 10)
118
Form 93
Application for search warrant (National Electricity Law s.21 or National Gas Law s.35) .........................120
Form 94
Search warrant (National Electricity Law s.21 or National Gas Law s.35) .................................................122
Form 95
Application for extension ...........................................................................................................................124
Form 96
Application for search warrant (Rail Safety National Law (SA) Act 2012, par 150 of the .............. Schedule)
126
Form 97
Search Warrant (Rail Safety National Law (SA) Act 2012, par 150 of the Schedule) .................................128
Form 98
Duplicate warrant (Rail and Safety National Law (SA) Act 2012, par 150 of the Schedule) ......................130
Form 99
Firearms prohibition order ........................................................................................................................132
Form 100
Application for disclosure of operatives identity in proceedings .........................................................136
Form 101
Suppression order ..................................................................................................................................138
Form 102A Notice of intention by the prosecution authority to adduce evidence of discreditable conduct..................
...........................................................................................................................................................139
Form 102B Notice of intention by a defendant to adduce evidence of discreditable conduct..................................141
Form 102C Notice of objection to proposed evidence of discreditable conduct .......................................................143
Form 103
Application for warrant (Correctional Services Act 1982 s 76 or 76A) ..................................................144
Form 104
Warrant (Correctional Services Act 1982 s76 or 76A) ...........................................................................146
Form 105
Order upon notification .........................................................................................................................147
Form 106
Interim non-association order and/or place-restriction order and summons ......................................148
Form 107
Non-association order and/or place-restriction order ..........................................................................152
Form 108
Application for variation or revocation of non-association order and/or place-restriction order..............

...............................................................................................................................................................156
Form 109
Publication Order ...................................................................................................................................158
Form 110
Application for spent conviction order and/or exemption order ..........................................................160
Form 111
Spent conviction order and/or exemption order ..................................................................................164
Form 112
Application for warrant (heavy Vehicle National Law (SA) Act 2013, Clause 506 of the ........... Schedule)
166
Form 113
Warrant (Heavy Vehicle National Law (SA) Act 2013, Clause 507 of the Schedule)..............................168
Form 114
Duplicate warrant (Heavy Vehicle National Law (SA) Act 2013, Clause 508 of the Schedule .....................
...............................................................................................................................................................170
Form 115
Affidavit..................................................................................................................................................172
Form 116
Application for enforcement warrant (Marine Safety (Domestic Commercial Vessel) Nation .......... Law
(Application) Act 2013, Schedule 1, Clause 135) ...........................................................................................................174
Form 117
Enforcement warrant (Marine Safety
(Domestic Commercial Vessel) National Law ....................................
Form 118
Duplicate warrant (Marine Safety (Domestic Commercial Vessel) National Law (Application) . Act 2013,
Schedule 1, Clause 136) .................................................................................................................................................178
Form 119
Application for warrant (Burial and Cremation Act 2013) .....................................................................180
Form 120
Warrant (Burial and Cremation Act 2013) .............................................................................................182
Form 01
Application for release on bail
FORM 1 - BAIL ACT 1985
(section 8(1))
APPLICATION FOR RELEASE ON BAIL

I, (insert full name)
(the applicant)
apply for bail.

Signature of Applicant:
Date of application:
Time of application:
hours
DECISION OF BAIL AUTHORITY

Tick appropriate box
Bail refused
(Form 2 Written record of reasons for refusal of bail

application must be completed except where the
authority refusing bail is a judge of the Supreme
Court or the District Court)
Bail granted
(Form 3 Grant of bail must be completed)
Full name of bail authority:

Bail authoritys signature:
Date:
Time:
hours
Form 06
Application for review of bail by Magistrate
Bail Act 1985

(sections 14(2)(b) and 15)
Application for review of bail by Magistrate

NoteIf the Supreme Court is to review the decision of the bail authority, the appropriate application form under the rules of the
Supreme Court must be completed and not this form.
Part A: Application
(Insert full name of person applying for release on bail)
of (insert address)
is
charged with /
has been convicted of
I, (insert name of applicant)

of (insert address)
apply to (insert name of court)

at
to review a decision of a bail authority, namely
(insert name of bail authority and brief description of decision)

made at
on
Applicants signature:
Date:
Part B: Review of bail by Magistrate by telephone under section 15

Name of magistrate contacted:
Date contact made:
Time of contact:
Result of review:
Refused /
Granted
Signature of member of police force

or justice who contacted the magistrate:
Note: Strike out Part B if the review of bail is to be heard in court.
Part C: Notice of Court hearing of review of bail
To
The person applying for release on bail
The police prosecutor at
The Director of Public Prosecutions
The guarantor of bail
The application for review of a bail authority, the details of which are set out in Part A, has been listed for hearing at
the Magistrates Court /
Youth Court sitting at
on (insert day and date)

at
am /
pm
All parties to the application must attend the hearing.

Court officers signature:
Date:
Note: Strike out Part C if the review of the bail is to be heard by telephone.
Form 07
Application to vary or revoke bail
FORM 7 BAIL ACT 1985
(Section 6(4))
APPLICATION TO VARY CONDITIONS OF BAIL AGREEMENT

APPLICATION TO REVOKE BAIL AGREEMENT
PART A: APPLICATION
(Insert full name of person released on bail)
of (insert address)
is
charged with /
and was granted bail on

of (insert address)
at
to -
vary the conditions of the bail agreement

revoke the bail agreement
I make this application on the following grounds:
Date:
PART B:
NOTICE OF HEARING
TO
The person on bail

The application to
vary the conditions of a bail agreement
the details of which are set out in Part A, has been listed for hearing at (insert name of court)

at
am /
pm

Date:
Form 7
Application to vary conditions of or revoke bail agreement
(Section 6(4))
APPLICATION TO VARY CONDITIONS OF BAIL AGREEMENT

APPLICATION TO REVOKE BAIL AGREEMENT
PART A: APPLICATION
of (insert address)
is
charged with /

of (insert address)
at
to -
vary the conditions of the bail agreement

Date:
PART B:
NOTICE OF HEARING
TO
The person on bail

The application to
vary the conditions of a bail agreement

at
am /
pm

Date:
Form 08
Application to vary terms of or revoke guarantee of bail
(Section 7(4))
APPLICATION TO VARY TERMS OF GUARANTEE OF BAIL

APPLICATION TO REVOKE GUARANTEE OF BAIL
PART A: Application
of (insert address)
is
charged with /
I, (insert name of guarantor)

of (insert address)
at
to -
vary the terms on my guarantee of bail

revoke my guarantee of bail
Guarantors signature:
Date:
PART B:
NOTICE OF HEARING
TO
The guarantor
The person on bail

The application to
vary the terms of a guarantee of bail
revoke a guarantee of bail,

at
am /
pm

Date:
Form 01
Complaint
Court Use
COMPLAINT
Magistrates Court of South Australia
www.courts.sa.gov.au
Summary Procedure Act, 1921

Sections 49
date filed
Complainant
Name:.................................................... , ..............................................
surname
...............................................
given name
Address..............................................
..............................................
Complainants reference
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
state
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
..................................
given name
dd/mmm/yy
Address...................................................................................................... ..................................
street
licence number
...............................................................................................................................................
city/town/suburb
state
postcode
Offence details
Other orders sought (forfeiture, compensation, additional penalty, destruction or the like Rule 15.03)
..............................
Date
Witness
..........................................
..........................................
Complainant
(Registrar, Deputy Registrar or Justice of the Peace)
(Not required if Complainant is a Public Authority)
Form 1
Form 02
complaint and summons

Form 2
Court Use
COMPLAINT AND SUMMONS


Sections 49 and 57
date filed
Complainant
Name:.................................................... , ..............................................
surname
Address..............................................
..........................................
given name
..............................................
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
state
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
..................................
given name
dd/mmm/yy
Address...................................................................................................... ..................................
street
licence number
...............................................................................................................................................
city/town/suburb
state
postcode
Offence details
..............................
..........................................
.........................................................................................................................................................
Date
Witness
Complainant

Important notice to Defendant

If you fail to appear on the hearing date set out below or on any day to which this matter is adjourned the Court may:
proceed in your absence or
issue a warrant for your arrest
Hearing details
.......................................
telephone
Registry.....................................................
Date....................................
Address.....................................................
Time .................................am/pm
.................................................
facsimile
........................................
e-mail address
...........................
MAGISTRATES COURT
Registrar/Justice of the Peace
PROOF OF SERVICE
Name of deponent:.....................................................................
Address of deponent:...................................................................
Name of person served:..............................................................
Address at which service effected:..............................................
Date service effected:..................................................................
Time of day: Between ............ am/pm and ..............am/pm
Method of service (tick box)

personally;
by leaving a copy at the last (or most usual) place of abode with a person apparently residing
there and not less than 16 years of age;
by leaving a copy at the place of business with a person apparently employed there and not less
than 16 years of age;
any other method permitted by the Rules specify

...........................................................................................
I certify that I served the attached document in the manner described.
Certified this....... day

of ................. 200...
) ..............................................
)
Form 03
Complaint and summons with form for plea

Form 3
Court Use
COMPLAINT AND SUMMONS


date filed
Sections 49 and 57
Complainant
Name:.................................................... , ..............................................
surname
Address..............................................
..........................................
given name
..............................................
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
facsimile
state
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
..................................
given name
Address...................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Offence details
..............................
Date
..........................................
Complainant

Hearing details
.......................................
telephone
Registry....................................................
Date....................................
Address....................................................
Time .................................am/pm
.................................................
facsimile
........................................
e-mail address
...........................
MAGISTRATES COURT
It is important that you read the information on the other side of this form.
If you intend
pleading
guilty
attend at court either in person or through a solicitor.

fill out this form, have it witnessed by one of the listed people and send it to the court
registry to which you were summonsed before the hearing date.
NOTE:- If you wish to apply to reduce the demerit points attracted by this offence you must
attend at court to give evidence.
written
guilty plea
I am the defendant in this matter.
I wish to plead guilty to the charge(s)
I wish to say:- (attach sheet if insufficient space)
............................................
date
..........................................................................
signed by defendant or its authorised Manager or Managing Director
Details of witness
JP/Solicitor/Police Officer number ..........................................
pleading not
guilty
.....................................................
signed by witness
Attend at court or have a solicitor attend for you and indicate a not guilty plea.
You will be expected to have discussed the issues in detail with the Complainant, or their
representative prior to a trial date being set
If you do not attend court you may be convicted and fined in your absence.
PROOF OF SERVICE
Name of deponent:.....................................................................
personally;
by leaving a copy at the last (or most usual) place of abode with a person apparently residing there and
not less than 16 years of age;
by leaving a copy at the place of business with a person apparently employed there and not less than 16
years of age;
by sending 2 copies by prepaid post.

...........................................................................................

of ................. 200...
) ..............................................
)
Form 04
Information
Form 4
Court Use
INFORMATION

date filed
Sections 101
Informant
Name:.................................................... , ..............................................
surname
Informants reference
Address..............................................
..........................................
given name
..............................................
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
facsimile
state
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
..................................
given name
Address...................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
Offence details
state
postcode
..............................
..........................................
..........................................
Date
Witness
Informant
(Not required if Informant is a Public Authority)
Form 05
Information and summons

Form 5
Court Use
INFORMATION AND SUMMONS


Sections 101 and 103
date filed
Informant
Name:.................................................... , ..............................................
surname
..........................................
given name
Address..............................................
..............................................
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
facsimile
state
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
..................................
given name
Address...................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Offence details
..............................
..........................................
..........................................
Date
Informant
Witness

(Not required if Informant is a Public Authority)

Hearing details
.......................................
telephone
Registry.....................................................
Date....................................
Address.....................................................
Time .................................am/pm
.................................................
facsimile
........................................
e-mail address
...........................
MAGISTRATES COURT
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;

...........................................................................................

of ................. 200...
) ..............................................
)
Form 5A
Summons
Form 5A
Court Use
SUMMONS

Sections 57 and 103
date filed
Complainant/Informant
Name:.................................................... , ..............................................
surname
Complainant/Informants reference
Address..............................................
..........................................
given name
..............................................
..................................
street
telephone
.................................................................................................
..........................................
city/town/suburb
postcode
facsimile
state
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
..................................
given name
Address...................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complaint/Information details
Date Complaint or Information made
............................................

Hearing details
Registry.....................................................
Date....................................
Address.....................................................
Time .................................am/pm
.......................................
telephone
.................................................
facsimile
........................................
e-mail address
...........................
MAGISTRATES COURT
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;

...........................................................................................

of ................. 200...
) ..............................................
)
Form 5B
Summons
Form 5B
Court Use
SUMMONS

Section 57A
(Where written plea of guilty is permitted)
date filed
Complainant
Name:.................................................... , ..............................................
surname
...........................................
given name
Address..............................................
Complainant/Informants reference
.............................................
street
.........................................
telephone
facsimile
.................................................................................................
city/town/suburb
state
...........................................
postcode
e-mail address
Defendant
Name:..................................................... , ................................................ DOB..................................
surname
given name
dd/mmm/yy
Address ..................................................................................................
...........................................
street
licence number
...............................................................................................................
city/town/suburb
state
postcode
Complaint
Date Complaint or Information made
............................................

If you fail to appear on the hearing date set out below or on any day to which this matter is adjourned the Court
may:
Hearing details
.......................................
telephone
Registry.....................................................
Date....................................
Address.....................................................
Time .................................am/pm
.................................................
facsimile
........................................
e-mail address
...........................
MAGISTRATES COURT
It is important that you read the information on the other side of this form.
If you intend
pleading
guilty
attend at court either in person or through a solicitor.

fill out this form, have it witnessed by one of the listed people and send it to the court registry
to which you were summonsed before the hearing date.
NOTE:- If you wish to apply to reduce the demerit points attracted by this offence you must
attend at court to give evidence.
written
guilty plea
I am the defendant in this matter.
I wish to plead guilty to the charge(s)
I wish to say:- (attach sheet if insufficient space)
............................................
date
..........................................................................
signed by defendant or its authorised Manager or Managing Director
Details of witness
JP/Solicitor/Police Officer number ..........................................
pleading not
guilty
.....................................................
signed by witness
Attend at court or have a solicitor attend for you and indicate a not guilty plea.
You will be expected to have discussed the issues in detail with the Complainant, or their
representative prior to a trial date being set
If you do not attend court you may be convicted and fined in your absence.
PROOF OF SERVICE
Name of deponent:.....................................................................
personally;

...........................................................................................
Certified this....... day of .............................. 20...
Form 06
Warrant of apprehension
Form 6
WARRANT OF APPREHENSION
Summary Procedure Act, 1921 - Section 58;

Bail Act 1985 - Section 18
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Originating Document Type
..........................................................
Date Substantiated on Oath
..........................................................
..........................................................
Defendant
Name:..................................................... , ................................................ DOB..................................
surname
dd/mmm/yy
given name
Address..................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Particulars of Charge
Date of Offence
.......................................................................
Offence Location
.......................................................................
Offence
.......................................................................
Section and Act
.......................................................................
(And
other charges)
Reason for Issue of Warrant

Date Warrant Issued
........................................................................
........................................................................
To the Commissioner of Police for the State of South Australia and each member of the Police Force for the State.
You are directed to apprehend the defendant and, subject to any endorsement below, bring the defendant as soon as practicable
before the Court to answer these charges and to be further dealt with according to law.
...........................
MAGISTRATES COURT
ENDORSEMENT
Pursuant to section 5(2)(b) of the Bail Act 1985
Variable 1 The defendant may not be released on bail.

Variable 2
At the discretion of a member of the Police Force who is of, or above, the rank of Sergeant or who is in charge of a
police station, the defendant may be released on bail.
Variable 3
Person or class of persons authorised/required to release the defendant on bail following arrest
...............................................
............................................................
Form 07
Warrant of remand
Form 7
WARRANT OF REMAND
Summary Procedure Act, 1921 - Sections 59, 103 and 112;

Criminal Law (Sentencing) Act 1988 - Section 19(4)
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Originating Document Type
..........................................................
..........................................................
Defendant
Name:..................................................... , ................................................ DOB..................................
surname
given name
dd/mmm/yy
Address..................................................................................................... ..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Particulars of Charge
Date of Offence
.......................................................................
Offence Location
.......................................................................
Offence
.......................................................................
Section and Act
.......................................................................
(And
other charges)
Particulars of Remand
Court Remanded to:
....................................................................
Date and Time Remanded to:
....................................................................
Reason for Remand:
....................................................................
Correctional Institution:
....................................................................
Bail Conditions where Certified

The defendant who has not yet entered into a bail agreement, may be bailed by agreement upon the following
conditions:
Date Warrant Issued:

To the Sheriff, Commissioner of Police for the State of South Australia and each Member of the Police Force of the
said State and to the Executive Director of the Department of Correctional Services.
The Sheriff and the Commissioner of Police and Members of the Police Force, are directed to take the defendant to
the specified correctional institution. The Executive Director of the Department of Correctional Services, is directed
to receive the defendant unless he/she has been bailed in the meantime, detain the defendant until the day and time
specified, and on that day and at that time to have the defendant before the Court to which the defendant was
remanded to be further dealt with according to law, unless some other order is made in the meantime.
...........................
MAGISTRATES COURT
TAKE NOTE
The requirements of s.19 of the Bail Act are such that if it becomes apparent that the defendant is not going to be
able to arrange bail in the terms certified above, then arrangements should be made for him/her to be brought back
before the court as soon as possible for the conditions to be reviewed.
In any event, if the defendant is not successful in arranging bail, then he/she must be brought back before the
court for the conditions to be reviewed within five days of the date of this warrant.
Prisoner movement arrangements should be made with the court on the day preceding the defendants court
appearance. If (after reviewing bail conditions) the court declines to vary the bail conditions certified on the warrant,
no further review is required.
Form 08
Form of election
Form 8
date filed
ELECTION FORM
Summary Procedure Act, 1921 - Section 103(2)
Registry
.............................................................
Address
...............................................................
File No
............................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Informant
surname
reference
Informants
given name
street
telephone
city/town/suburb
state
facsimile
postcode
e-mail address
Defendant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
The information to which this form is attached contains minor indictable (*and summary) charges.
You have the right to choose how the charge(s) will be dealt with
*
by a Magistrate; or
* by a Judge and Jury in the District Court
If you want the charge(s) dealt with in the District Court you MUST complete this form and return it to the
Magistrates Court.
Election
Defendants solicitor
....................................................
telephone
Defendants counsel
facsimile
e-mail
....................................................
telephone
facsimile
e-mail
Defendant to note: If you have changed your address, please supply details below:
.................................................................................
..............................................................................
New address
New telephone
IT IS ADVISABLE NOT TO COMPLETE THIS FORM

N.B. (1)
AN ELECTION DOES NOT TAKE EFFECT UNTIL THIS COMPLETED FORM IS FILED IN
THE COURT AT THE ABOVE ADDRESS. IT MUST BE LODGED (a)
Where a summary of the evidence has been requested by the defence or directed by
the Court - within 14 days of the delivery of the summary;
(b)
UNLESS YOU HAVE HAD LEGAL ADVICE
Where there is no request or direction for a summary - not later than 6 weeks after the
defendant's first appearance before the Court.
(2)
A COPY OF THE INFORMATION TO WHICH THIS FORM RELATES MUST BE ATTACHED

WHEN IT IS FILED.
(3)
YOU MAY NOT ELECT FOR TRIAL BEFORE A JUDGE SITTING WITHOUT A JURY {S.7(2)
JURIES ACT 1927}
Delete as appropriate
Form 09
Written plea admitting charge

Form 9
WRITTEN PLEA ADMITTING CHARGE

Summary Procedure Act, 1921 - Section 105(1)(a)
Registry
.............................................................
Address
...............................................................
File No
Court Use
date filed
............................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Informant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ..............................................
street
facsimile
..................................
telephone
.................................................................................................
city/town/suburb
e-mail address
state
..........................................
postcode
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
Address
..................................
given name
......................................................................................................
..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
I admit all charges in the attached Information and understand that I will be committed to a Superior Court for
sentence.
[If there is no major indictable charge you must first complete an ELECTION FORM before completing this
form.]
I certify that the defendant has had legal advice in
respect of this plea
.................................................
............................................
Defendant
solicitor
...........................................
date
....................................................
..........................................
............................................ .................................................
telephone
facsimile
e-
mail
Defendants counsel
....................................................
..........................................
............................................ .................................................
telephone
facsimile
e-
mail
Defendant to note: If you have changed your address, please supply details below:
.....................................................................
..................................................................
New address
New telephone number
NOTE
(1)
If you complete this form, it must be lodged with the Court before the date set for your
appearance A copy of the INFORMATION to which this form relates must be attached
when it is filed. If you do that, you need not appear. You will be informed of the date and
time that you are to appear in the Superior Court.
(2)
If there is NO MAJOR INDICTABLE charge and you want the Magistrates Court to
impose penalty on your plea of guilty, you must attend at the Magistrates Court hearing
in person.
You must do one or other, or a WARRANT for YOUR ARREST may be issued without further notice.
Form 9A
Admission and consent to sentence

Form 9A
ADMISSION AND CONSENT TO SENTENCE

Summary Procedure Act 1921
Section 108
Court Use
Date Filed:
It is advisable not to complete this form unless you have had legal advice
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Informant
Name
Surname
Given name/s
Street
AP Number
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Defendant
Full Name
DOB
dd/mm/y
yyy
Street
Address
City/Town/Suburb
State
Postcode
The Information to which this form is attached contains major indictable charges.
You can admit the charge/s and consent to be sentenced by a Magistrate, rather than a Judge in the District
or Supreme Court. The Director of Public Prosecutions must also consent.
If you want to admit the charge/s and consent to be sentenced by a Magistrate you MUST complete this
form.
Admission and Consent
I admit the following major indictable charge/s and consent to being sentenced by the Magistrates Court:
.............................................
...............................................................
Date
Defendant
I certify that the defendant has had legal advice in respect of this admission and consent.
.............................................
...............................................................
Date
Defendants Solicitor
Solicitors Name
Telephone:
Facsimile:
Email:
.............................................
..............................................................
Date
Defendants Counsel
Counsels Name
Telephone:
Facsimile:
Email:
On behalf of the Director of Public Prosecutions, I consent to the defendant being sentenced by the
Magistrates Court.
.............................................
..............................................................
Date
Director of Public Prosecutions
Prosecutors Name
Telephone:
Facsimile:
Email:
IMPORTANT NOTICE
This form must be presented to the Court either at the time the defendant appears before the Court or at the
time the defendant returns a written plea of guilty.
A copy of the information to which this admission and consent relate must be attached.
Form 10
Order of committal
Form 10
COMMITTAL FOR TRIAL/SENTENCE

Summary Procedure Act, 1921 - Section 105 and 107
Registry
....................................................
File No
Address
...............................................................
............................................
............................................
..................................
............................................
telephone
facsimile
e-mail address
Defendant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
Presiding Officer
state
postcode
..........................................................................
Nature of Committal
trial
sentence
Court
Supreme Court
District Court
Sitting place: ..........................

Charges:
An alibi notice has been given to the defendant.
* A copy of Section 69(3) of the Judiciary Act has been given to the defendant.
(* delete if not applicable)
BAIL STATUS
on bail
telephone
Defendants counsel
telephone
in custody, bail certified
in custody, bail refused
....................................................
facsimile
e-mail
....................................................
facsimile
e-mail
Form 11
Summons to witness
Form 11
WITNESS SUMMONS
Magistrates Court Act, 1991, Section 20
Registry
.............................................................
Address
...............................................................
File No............................................
...............................................................
............................................
............................................
telephone
facsimile
........................................
....
e-mail address
Witness
Name:
..............................................................................................
Address:
..............................................................................................
Case details
surname
given name
Offence
.......................................................................
.......................................................................
Date of Offence
.......................................................................
Offence Location
.......................................................................
What you need to do: (for detailed explanation see attached sheet)
Attend Court to give evidence on the hearing date
Bring the Evidentiary Material listed below
Deliver the Evidentiary Material listed below to the Registrar before the hearing
Evidentiary Material:
Hearing details
am/pm
telephone
facsimile
e-mail address
(delete as appropriate)
telephone
facsimile
e-mail address
Date:.............................
...............
............
MAGISTRATES COURT
The Seal of the Court is to be fixed to this form.
Information about this summons.

Unless the summons has the Seal of the Magistrates Court on it, it has not been properly issued
and therefore doesnt need to be obeyed.
What is this document?

What do you have to do?
If the summons requires you to produce documents or things only, you may comply with it by
delivering all of the documents or things to the Registrar of the Magistrates Court at the address given
prior to the time and date on the summons.
If you do that, you do not have to attend on the day and at the time shown on the summons.You
should only deliver documents or things to the Registrar if you have all of the documents or things
requested and if you have no objection to producing them to the Court and to them being
inspected by the parties to the case.
If you do deliver the documents or things to the Registrar, they should be securely packaged and
have a copy of this summons attached.If you object to the parties seeing the documents or things,
you must come to court on the day and at the time listed and tell the Magistrate why you object to
producing them.
If the summons requires you to give evidence (whether or not it also requires you to bring
documents or things), you must attend at the Registry on the day shown in sufficient time to be in the
correct courtroom by the time listed unless you contact the person who had this summons issued and
have arranged to come to court at some other time.
What about the cost of attending court?

In addition to your reasonable expenses of attending at Court, you are also entitled to be paid by the party
who had the summons issued this summons, your reasonable expenses incurred in complying with the
summons, including an appropriate witness fee.
If you need all or some of these expenses paid before you come to court, you should contact the party who
had the summons issued.
If you do not understand what you must doThe Registrar of the court that issued the
summons;
The person the applied to issue the summons; or

A solicitor to obtain your own legal advice.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by leaving a copy at the last (or most usual) place of abode with a person apparently
residing there and not less than 16 years of age;
by leaving a copy at the place of business with a person apparently employed there and

...........................................................................................

of ................. 200...
) ..............................................
)
Form 12
Warrant to arrest witness

Form 11
WITNESS SUMMONS
Magistrates Court Act, 1991, Section 20

Registry
.............................................................
Address
...............................................................
File No............................................
...............................................................
............................................
............................................
telephone
facsimile
........................................
....
e-mail address
Witness
Name:
..............................................................................................
Address:
..............................................................................................
Case details
surname
given name
Offence
.......................................................................
.......................................................................
Date of Offence
.......................................................................
Offence Location
.......................................................................
What you need to do: (for detailed explanation see attached sheet)
Attend Court to give evidence on the hearing date
Bring the Evidentiary Material listed below
Deliver the Evidentiary Material listed below to the Registrar before the hearing
Evidentiary Material:
Hearing details
am/pm
telephone
facsimile
e-mail address
(delete as appropriate)
telephone
facsimile
Date:.............................
e-mail address
...............
............
MAGISTRATES COURT
The Seal of the Court is to be fixed to this form.
Information about this summons.

Unless the summons has the Seal of the Magistrates Court on it, it has not been properly issued
and therefore doesnt need to be obeyed.
What is this document?

What do you have to do?
If the summons requires you to produce documents or things only, you may comply with it by
delivering all of the documents or things to the Registrar of the Magistrates Court at the address given
prior to the time and date on the summons. If you do that, you do not have to attend on the day and
at the time shown on the summons.
You should only deliver documents or things to the Registrar if you have all of the documents or
things requested and if you have no objection to producing them to the Court and to them
being inspected by the parties to the case.
If you do deliver the documents or things to the Registrar, they should be securely packaged and
have a copy of this summons attached.
If you object to the parties seeing the documents or things, you must come to court on the day and at
the time listed and tell the Magistrate why you object to producing them.
If the summons requires you to give evidence (whether or not it also requires you to bring
documents or things), you must attend at the Registry on the day shown in sufficient time to be in the
correct courtroom by the time listed unless you contact the person who had this summons issued and
have arranged to come to court at some other time.
What about the cost of attending court?

In addition to your reasonable expenses of attending at Court, you are also entitled to be paid by the party
who had the summons issued this summons, your reasonable expenses incurred in complying with the
summons, including an appropriate witness fee.
If you need all or some of these expenses paid before you come to court, you should contact the party who
had the summons issued.
If you do not understand what you must doThe Registrar of the court that issued the
summons;
The person the applied to issue the summons; or

A solicitor to obtain your own legal advice.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;

...........................................................................................

of ................. 200...
) ..............................................
)
Form 13
Notice to produce person from custody

Form 13
NOTICE TO PRODUCE PERSON IN CUSTODY

Magistrates Court Act, 1991 - Section 23 &

Correctional Services Act, 1982 Section 28
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Details of person to be brought before the Court

surname
Institution
given name
dd/mmm/yy
.....................................................................................................
Capacity in which person is required to attend:-
Particulars of Case
surname
reference
Complainants
given name
street
telephone
city/town/suburb
state
Person Charged
facsimile
postcode
e-mail address
..........................................................................................................
To the Manager of the Institution at which the person is in custody.

The person mentioned is required to attend before the Court in this matter.
You are required to produce the person at.
Registry
.............................................................
Date........................................
Time
Date
MAGISTRATE
Form 14
Warrant to bring person from institution to a court (Magistrates Court Act 1991, s.23)
Form 14
WARRANT TO BRING PERSON IN CUSTODY

Magistrates Court Act, 1991 - Section 23
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Details of person to be brought before the Court

surname
Institution
given name
dd/mmm/yy
.....................................................................................................
Particulars of Case
surname
reference
Complainants
given name
street
telephone
city/town/suburb
state
Person Charged
facsimile
postcode
e-mail address
..........................................................................................................
To the Sheriff, the Commissioner of Police and any member of the South Australian Police Force.
The person mentioned is required to attend before the Court as a witness in this matter.
You are required to produce the person as follows.
Registry
.............................................................
.........................................
date
Date
Time
..................
..
...........................
MAGISTRATES COURT
Form 15
Notice in respect of drivers licence pursuant to section 27c(2) or section 27c(3)

Form 15
NOTICE TO DEFENDANT AS TO PENALTY

Summary Procedure Act, 1921 - Section 27C(3), Section 62C(2), Rule 15.01
Registry
...........................................................
File No
............................................
Defendant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
You have been convicted in your absence of the following offence(s)
drivers licenceYou should attend Court or have a solicitor attend for you.
If you fail to attend a warrant may be issued for your arrest.
Next hearing
am/pm
telephone
date
facsimile
e-mail address
...........................
MAGISTRATES COURT
IF YOU WISH TO DISPUTE THESE CHARGES YOU SHOULD READ THE INFORMATION ON THE BACK
OF THIS FORM
NOTICE TO DEFENDANT
RE-HEARING
Section 76a of the Summary Procedure Act provides that the Court may, on its own initiative or on the application
of any party, set aside a conviction or order provided that:
(a)
the parties consent to have it set aside
(b)
the conviction or order was made in error
(c)
it is in the interest of justice to set aside the conviction or order.
If you wish to have the conviction or order set aside, you must complete the application appearing below, and
return this notice so as to reach the Registrar within fourteen days of the day on which you received this notice.
You or your solicitor must then attend Court on the date and time to which this matter has been adjourned (as
detailed on this notice) to support your application.
If you do not apply to have the conviction or order set aside within fourteen days of the receipt of this notice the
conviction or order will stand.
APPLICATION FOR RE-HEARING
I, the defendant named in this notice, hereby apply for a re-hearing of the charge referred to in this notice.
Dated this
day of
20
............................................
...............................................................
date
Applicant)
(Signature of
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................

of ................. 200...
) ..............................................
)
Form 15A
Summons to person substantially affected

Form 15A
SUMMONS TO PERSON SUBSTANTIALLY AFFECTED

Road Traffic Act 1961 Section 168(2)
Registry
.............................................................
File No............................................
Address
..............................................................................................................................
............................................
............................................
.........................................
telephone
facsimile
e-mail address
Details of person affected by order

Name:
surname
Address:
given name
dd/mm/yyyy
..............................................................................................
Case details
surname
given name
dd/mm/yyyy
The defendant has been convicted of an offence against the Road Traffic Act 1961 relating to motor
vehicles or an offence in the commission of which a motor vehicle was used or the commission of
which was facilitated by the use of a motor vehicle.
The court may make one or more of the following order(s):
that the defendant be disqualified from holding or obtaining a drivers licence for a period fixed by the
court or until further order;
that the defendant so disqualified be not, at the end of the period of disqualification or on the removal
of the disqualification, granted a drivers licence until the person passes a driving test as prescribed by
section 79A of the Motor Vehicles Act 1959;
that a drivers licence held by the defendant be modified for a period fixed by the court or until further
order;
that the registration of the motor vehicle concerned under the Motor Vehicles Act 1959 be suspended
for a period fixed by the court or until further order, or be cancelled;
that the defendant, and any associate of the person, be disqualified from obtaining registration of the
motor vehicle concerned as an owner or operator under the Motor Vehicles Act 1959 for a period fixed
by the court or until further order.
You may be substantially affected by the order(s), and you are summoned to show cause why the
order should not be made. You need not appear in answer to this summons, but if you do not, orders
may be made in your absence.
Hearing details
am/pm
telephone
facsimile
e-mail address
Date:.............................
..............
.........
MAGISTRATES COURT
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;

...........................................................................................
) ..............................................
of ................. 20.
Form 16
Notice of order of forfeiture, destruction, compensation etc

Form 16
NOTICE TO DEFENDANT AS TO PENALTY SOUGHT

Summary Procedure Act, 1921 - Rule 15.02
Registry
...........................................................
File No
............................................
Defendant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
You have been dealt with in your absence of the following offence(s)
An application has been made for:
You should attend Court or have a solicitor attend for you.

If you fail to attend
the matter may be dealt with without you, or
a warrant may be issued for your arrest.
Next hearing
am/pm
telephone
facsimile
date
e-mail address
...........................
MAGISTRATES COURT
IF YOU WISH TO DISPUTE THESE CHARGES YOU SHOULD READ THE INFORMATION ON THE
BACK OF THIS FORM
NOTICE TO DEFENDANT
RE-HEARING
Section 76a of the Summary Procedure Act provides that the Court may, on its own initiative or on the
application of any party, set aside a conviction or order provided that:
(a)
the parties consent to have it set aside
(b)
the conviction or order was made in error
(c)
it is in the interest of justice to set aside the conviction or order.
If you wish to have the conviction or order set aside, you must complete the application appearing below, and
return this notice so as to reach the Registrar within fourteen days of the day on which you received this
notice. You or your solicitor must then attend Court on the date and time to which this matter has been
adjourned (as detailed on this notice) to support your application.
If you do not apply to have the conviction or order set aside within fourteen days of the receipt of this notice
the conviction or order will stand.
APPLICATION FOR RE-HEARING

I, the defendant named in this notice, hereby apply for a re-hearing of the charge referred to in this notice.
Dated this
day of
............................................
date
20
...............................................................
(Signature of Applicant)
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................
Certified this....... day .............................................of ................. 200...
Form 17
Notice of previous convictions

Form 17
NOTICE OF PREVIOUS CONVICTIONS

Summary Procedure Act, 1921 - Section 62D
Registry
...........................................................
File No
............................................
Person charged
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
Charges against you
If you are convicted of these offences, the following previous convictions will be alleged against you.
You should attend Court or have a solicitor attend for you.

If you fail to attend
the matter may be dealt with without you, or
a warrant may be issued for your arrest.
Person or agency alleging previous convictions.

surname
given name
street
Reference
telephone
city/town/suburb
state
facsimile
postcode
e-mail address
Next hearing
am/pm
telephone
date
facsimile
e-mail address
..................................................................
Complainant
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................
.............................................of ................. 200...
Form 18
Notice of penalty
Form 18
NOTICE OF PENALTY
Date Posted:
Name
Address
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
In your absence you have been convicted of the following offence(s):

Date
Imposed
Offence
You are disqualified from holding or obtaining a drivers licence commencing on
Offence
Date
Penalty Due
(Inc. costs etc)
and ending at midnight on
NOTE: You must not, under any circumstances drive any form of motor vehicle on a road or street (or any place to
which the public have access) during the term of your disqualification.
Driving under disqualification is a serious offence for which you can be imprisoned for up to 6 months
for a first offence or up to two years for a second. Imprisonment is the penalty most often ordered by
the court for this offence.
Payment Advice
The amount is due within 28 days of the date it was imposed. You will need to pay the penalty within 28 days of this
notice or enter into a payment arrangement with the Fines Enforcement and Recovery Officer. For all payment options
please contact the Fines Enforcement and Recovery Unit on 1800 659 538 or seek further information from
www.fines.sa.gov.au.
NOTICE TO THE DEFENDANT
RE-HEARING
Section 76A of the Summary Procedure Act 1921 provides that the Court may, on its own initiative or on the
application of any party, set aside a conviction or order provided that:
a) the parties consent to have it set aside
b) the conviction or order was made in error
c) it is in the interest of justice to set aside the conviction or order
If you wish to have the conviction or order set aside, you must complete the application for Rehearing (Form 19) and
file this application within 14 days of the day on which you received this notice, An application for Rehearing can be
obtained online at www.courts.sa.gov.au/ForLawyers/Pages/Magistrates-Court-Criminal-Forms.aspx or by contacting
the Call Centre on (08) 8204 2444.
If you do not apply to have the conviction or order set aside within 14 days of the receipt of this notice the conviction or
order will stand.
Form 19
Application for rehearing

Form 19
APPLICATION FOR REHEARING


Section 76A
Registry at which conviction or order made:
File No.
Details of original file:

Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
Street
Licence No.
Address
City/Town/Suburb
State
Postcode
Name
Surname
Complainants Reference
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Charges:
I now apply to have the conviction or order set aside.

My reason(s) for wanting to set it aside is/are:
.....................................................
Applicants signature
State whether Applicant is
Registry
Hearing details
Address
Complainant
Defendant
Registrar
Date
Time
am/pm
Telephone
Facsimile
Email Address
............................................
............................................
..............................................................
Date
MAGISTRATES COURT
IMPORTANT NOTICE TO APPLICANT

An application to set aside a conviction or order must be made within 14 days after the applicant receives notice of
the conviction or order.
Form 20
Notice of committal on written plea of guilty

Form 20
NOTICE OF OUTCOME OF HEARING OF INDICTABLE

OFFENCE
Summary Procedure Act, 1921 - Section 105(1)(a) and Rule 22.07
Registry
...........................................................
File No
............................................
Defendant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
surname
reference
Complainants
given name
street
telephone
city/town/suburb
state
facsimile
postcode
e-mail address
Charges
You pleaded guilty to these charges. You have been committed for sentence as follows
am/pm
telephone
facsimile
e-mail address
If you do not attend on that day a warrant may be issued for your arrest.
............................................
Date
...........................................................
Registrar
Form 21A Important information for defendants committed for trial to the Supreme or District Court (State
Prosecutions)
Form 21A
IMPORTANT INFORMATION FOR DEFENDANTS

committed for trial to the Supreme or District Court
(State Prosecutions)
Summary Procedure Act, 1921 - Section 107(5)
Notice to Defendant
If you are on bail, you will be required to appear before a Judge of the Court to which you
have been committed on __________ at _______ a.m.
If you are in custody you will be taken to the Court on the day on which you are required to
appear.
If you plead not guilty before the Judge, you will be remanded for trial and the Judge will
adjourn your case to a particular date and time for a directions hearing.
Directions hearings are held so that arrangements can be made for the trial, including the
fixing of the date for the trial.
There may be more than one directions hearing and you will be required to attend on each
occasion, unless excused by the Judge.
REDUCTION FOR A PLEA OF GUILTY
When a person is sentenced to imprisonment, the Court may reduce the length of the
sentence if the person pleads guilty to the offence. The amount of discount will depend
on how early the plea of guilty takes place and the circumstances of the case.
ALIBI EVIDENCE
Alibi evidence is evidence that you were at some place other than the scene of the alleged
offence(s) at the relevant time.
If you wish to call alibi evidence at your trial and the evidence was not given at your
committal hearing, you must give written notice of the evidence to the Director of Public
Prosecutions within seven (7) days from the date on which you were committed for trial.
The notice MUST BE IN WRITING AND CONTAIN:
1
a summary setting out with reasonable particularity the facts sought to be established by
that evidence;
the name and address of any witness by whom the evidence is to be given;
and MUST BE DELIVERED OR POSTED to The Director of Public Prosecutions at

7th Floor
or
45 Pirie Street
ADELAIDE, SA 5000
GPO Box 464

ADELAIDE, SA 5001
or
DX 336
If you do not give notice you will still be able to call alibi evidence, but the Prosecutor and the
Judge will be able to comment to the jury on your failure to give notice of that evidence before
the trial.
If you do give notice the Prosecutor may not, after the close of the Prosecution case, give
evidence in rebuttal of your alibi evidence unless given leave by the Judge.INFORMATION
WHICH YOU MAY BE REQUIRED TO GIVE TO THE DIRECTOR OF PUBLIC
PROSECUTIONS
The Judge presiding over a directions hearing may authorise the Director of Public
Prosecutions to serve you with a notice or notices requiring you to provide information in
relation to the following matters.
ADMITTING FACTS
The Judge may authorise the Director of Public Prosecutions to serve on you a notice to
admit certain facts about your case.
The purpose of this procedure is to shorten the trial, if possible, by agreeing matters which
are not in dispute. This saves the calling of some of the witnesses.
You are not required to admit these facts, but if you unreasonably fail to admit them and you
are convicted of the offence(s) with which you are charged, the Court may take your failure to
admit the facts into account in fixing sentence.
You would unreasonably fail to admit such facts if, for example, you claimed privilege against
incriminating yourself as a reason for not making the admission and made the prosecution
prove facts which were not seriously contested at your trial.
NOTIFICATION OF PROSECUTION WITNESSES WHO ARE NOT REQUIREDThis is another
way in which the trial might be shortened where some of the evidence is not in dispute.
The Judge may require you to notify the Director of Public Prosecutions in writing whether
you consent to the prosecution not calling witnesses to prove the admissibility of the following
kinds of evidence:
(a) documentary, audio, visual, or audiovisual evidence of surveillance or
interview;
(b) other documentary, audio, visual or audiovisual evidence;
(c)
exhibits.
If you fail to comply with such a notice, the Court will assume you have no objection.
NOTICE OF DEFENCESThe Judge may require you to give written notice to the Director of
Public Prosecutions if you intend to call evidence at the trial which tends to establish that
you are mentally unfit to stand trial.

you were mentally incompetent to commit the alleged offences.
the circumstances of the alleged offence(s) occurred by accident.
you were entitled to any property which is the subject of the offence(s).
you were acting for a defensive purpose.
you were intoxicated at the time of the alleged offence(s).
The Judge may also require you to give written notice to the Director of Public Prosecutions if
you intend to call evidence at the trial relating to the defences of provocation, automatism,
necessity or duress.
If you fail to give the Director of Public Prosecutions notice of any of these matters, you may
call evidence about them but the prosecutor or the Judge or both may comment to the jury on
your failure to give notice.
EXPERT EVIDENCE
If expert evidence is to be called for the defence at the trial, written notice of your intention to
call the evidence must be given to the Director of Public Prosecutions on or before the date of
the first directions hearing or, if the evidence does not become available to the defence until
later, as soon as practicable after it becomes available to the defence.

The notice must set out the name and qualifications of the expert and describe the general
nature of the evidence and what it tends to establish.
The notice must be given in Form No. 15 of the Supreme/District Court Criminal Rules.
If you wish to introduce expert psychiatric evidence or other expert medical evidence relevant
to your mental state or medical condition at the time of the alleged offence(s), the Judge may
require you to submit to an examination by an independent expert approved by the Court.
If you fail to submit to a psychiatric or other medical examination as required by the Court, the
Court will not allow you to call expert psychiatric or medical evidence which you wish to
tender to the Court.
If you fail to comply with any other requirement in relation to expert evidence, you will not be
allowed to call the evidence without the Courts permission and the prosecutor or the Judge
may comment on your non-compliance to the jury.
Form 21B
Information for defendants committed for trial (Commonwealth Prosecutions)

Form 21B
IMPORTANT INFORMATION FOR DEFENDANTS

committed for trial to the Supreme or District Court
(Commonwealth Prosecutions)
Summary Procedure Act, 1921 (SA) - Section 107(5) and the Judiciary Act 1903 (Cth)
Section 69(3)
Notice to Defendant
If you are on bail, you will be required to appear before a Judge of the Court to which you
have been committed on __________ at _______ a.m.
If you are in custody you will be taken to the Court on the day on which you are required to
appear.
If you plead not guilty before the Judge, you will be remanded for trial and the Judge will
adjourn your case to a particular date and time for a directions hearing.
Directions hearings are held so that arrangements can be made for the trial, including the
fixing of the date for the trial.
There may be more than one directions hearing and you will be required to attend on each
occasion, unless excused by the Judge.
REDUCTION FOR A PLEA OF GUILTY

When a person is sentenced to imprisonment, the Court may reduce the length of the
sentence if the person pleads guilty to the offence. The amount of discount will depend
on how early the plea of guilty takes place and the circumstances of the case.
ALIBI EVIDENCE
Alibi evidence is evidence that you were at some place other than the scene of the alleged
offence(s) at the relevant time.
If you wish to call alibi evidence at your trial and the evidence was not given at your
committal hearing, you must give written notice of the evidence to the Director of Public
Prosecutions within seven (7) days from the date on which you were committed for trial.
The notice MUST BE IN WRITING AND CONTAIN:
1
a summary setting out with reasonable particularity the facts sought to be established by
that evidence;
the name and address of any witness by whom the evidence is to be given;
and MUST BE DELIVERED OR POSTED to The Commonwealth Director of Public

Prosecutions at
11th Floor
45 Grenfell Street
or
GPO Box 2562

ADELAIDE, SA 5001
ADELAIDE, SA 5000
or
DX 455
If you do not give notice you will still be able to call alibi evidence, but the Prosecutor and the
Judge will be able to comment to the jury on your failure to give notice of that evidence before
the trial.
If you do give notice the Prosecutor may not, after the close of the Prosecution case, give
evidence in rebuttal of your alibi evidence unless given leave by the Judge.INFORMATION
WHICH YOU MAY BE REQUIRED TO GIVE TO THE DIRECTOR OF PUBLIC
PROSECUTIONS
The Judge presiding over a directions hearing may authorise the Director of Public
Prosecutions to serve you with a notice or notices requiring you to provide information in
relation to the following matters.
ADMITTING FACTS
The Judge may authorise the Director of Public Prosecutions to serve on you a notice to
admit certain facts about your case.
The purpose of this procedure is to shorten the trial, if possible, by agreeing matters which
are not in dispute. This saves the calling of some of the witnesses.
You are not required to admit these facts, but if you unreasonably fail to admit them and you
are convicted of the offence(s) with which you are charged, the Court may take your failure to
admit the facts into account in fixing sentence.
You would unreasonably fail to admit such facts if, for example, you claimed privilege against
incriminating yourself as a reason for not making the admission and made the prosecution
prove facts which were not seriously contested at your trial.
NOTIFICATION OF PROSECUTION WITNESSES WHO ARE NOT REQUIREDThis is another
way in which the trial might be shortened where some of the evidence is not in dispute.
The Judge may require you to notify the Director of Public Prosecutions in writing whether
you consent to the prosecution not calling witnesses to prove the admissibility of the following
kinds of evidence:
(b) documentary, audio, visual, or audiovisual evidence of surveillance or
interview;
(b) other documentary, audio, visual or audiovisual evidence;
(c)
exhibits.
If you fail to comply with such a notice, the Court will assume you have no objection.
NOTICE OF DEFENCESThe Judge may require you to give written notice to the Director of
Public Prosecutions if you intend to call evidence at the trial which tends to establish that
you are mentally unfit to stand trial.
you were mentally incompetent to commit the alleged offences.
the circumstances of the alleged offence(s) occurred by accident.
you were entitled to any property which is the subject of the offence(s).
you were acting for a defensive purpose.
you were intoxicated at the time of the alleged offence(s).
The Judge may also require you to give written notice to the Director of Public Prosecutions if
you intend to call evidence at the trial relating to the defences of provocation, automatism,
necessity or duress.
If you fail to give the Director of Public Prosecutions notice of any of these matters, you may
call evidence about them but the prosecutor or the Judge or both may comment to the jury on
your failure to give notice.
EXPERT EVIDENCE
If expert evidence is to be called for the defence at the trial, written notice of your intention to
call the evidence must be given to the Director of Public Prosecutions on or before the date of
the first directions hearing or, if the evidence does not become available to the defence until
later, as soon as practicable after it becomes available to the defence.
The notice must set out the name and qualifications of the expert and describe the general
nature of the evidence and what it tends to establish.
The notice must be given in Form No. 15 of the Supreme/District Court Criminal Rules.
If you wish to introduce expert psychiatric evidence or other expert medical evidence relevant
to your mental state or medical condition at the time of the alleged offence(s), the Judge may
require you to submit to an examination by an independent expert approved by the Court.
If you fail to submit to a psychiatric or other medical examination as required by the Court, the
Court will not allow you to call expert psychiatric or medical evidence which you wish to
tender to the Court.
If you fail to comply with any other requirement in relation to expert evidence, you will not be
allowed to call the evidence without the Courts permission and the prosecutor or the Judge
may comment on your non-compliance to the jury.
Notice to Defendant
Judiciary Act 1903 (Commonwealth) Any person committed for trial for an offence against the laws of
the Commonwealth may at any time within fourteen days after committal and before the jury is sworn
apply to a Justice in Chambers or to a Judge of the Supreme Court of a State for the appointment of
counsel for his or her defence. If it be found to the satisfaction of the Justice or Judge that such person
is without adequate means to provide defence for himself or herself, and that it is desirable in the
interests of justice that such an appointment should be made, the Justice or Judge shall certify this to
the Attorney General, who may if he or she thinks fit thereupon cause arrangements to be made for the
defence of the accused person or refer the matter to such legal aid authorities as the Attorney General
considers appropriate. Upon committal the person committed shall be supplied with a copy of this
subsection.
Form 22
Application to vary a community service order

Form 22
APPLICATION TO VARY A COMMUNITY SERVICE

ORDER
Date filed:
Date served on
respondent:
Criminal Law (Sentencing) Act 1988
Date served on Minister for

Correctional Services:
Section 50A(1), (2)

Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Applicant
Name
Surname
Given name/s
Street
Facsimile
Telephone
Address
City/Town/Suburb
State
Postcode
Email Address
Person subject to the Community Service Order

DOB
Name
Surname
Given name/s
dd/mm/yyyy
Street
Telephone
Address
City/Town/Suburb
State
Postcode
Email Address
Community Service Order

Date of the order:
Court in which the order was made:
Charge/s relating to the order:
Details of the order are:
To perform
hours of community service within
months from the date of order.
The Community Service Order has not expired at the date of the application.
Number of community service hours performed in respect of the order:
I now make an application to the court to:
vary the terms of the order
vary or revoke an ancillary order, namely:
..................................................
.......................................................................
Date
APPLICANT
Registry
Hearing details
Address
Date
Time
am/pm
Telephone
Facsimile
Email Address
............................................
............................................
..............................................................
Date
MAGISTRATES COURT
IMPORTANT NOTICE TO THE APPLICANT

You are required to attend on this date to support your application.
IMPORTANT NOTICE TO THE REGISTRAR
A copy of this application must be served on the Minister for Correctional Services or the person subject to the Community
Service Order.
Application miscellaneous statutory jurisdiction section 10 rule 29 Magistrates

Court Act
Form 23
Form 23
APPLICATION FOR AN ORDER OF THE COURT

Magistrates Court Act, 1991 - Section 10 - Rule 29
Registry
...........................................................
File No
............................................
Applicant
surname
given name
dd/mmm/yy
street
licence number
city/town/suburb
state
postcode
Person or property the subject of the order sought.

surname
given name
street
city/town/suburb
Reference
telephone
state
facsimile
postcode
e-mail address
Grounds of Application
Details of order applied for
..
Applicant
Next hearing date

am/pm
telephone
date
facsimile
e-mail address
Registrar
A copy of this application is to be served on both the Applicant and the Respondent
If you do not attend on the hearing date, or any adjourned hearing date, orders may be made
in your absence
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;

...........................................................................................

of ................. 200...
) ..............................................
)
Form 24
Warranty of commitment - contempt

Form 24
WARRANT OF COMMITMENT
(Contempt of Court)
Magistrates Court Act 1991 - Sections 45 and 46
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
..........................................................
Defendant
surname
given name
dd/mmm/yy
street
city/town/suburb
licence number
state
postcode
Offence
Date of offence
.......................................................................
Offence location
.......................................................................
Section and Act
.......................................................................
Sentence
Term of imprisonment ordered:
....................................................................
Total imprisonment to be served:
....................................................................
Commencement date:
....................................................................
Non - parole period set
....................................................................
Non - parole period

commencement date:
....................................................................
Date order made:
....................................................................
Date warrant issued:
....................................................................
This defendant has been dealt with by a Court and sentenced to a term of imprisonment.
The Sheriff, Commissioner of Police for the State of South Australia and each Member of the Police Force of
the State are directed to take the defendant to a specified correctional institution.
The Chief Executive Officer of the Department for Correctional Services is directed to detain the defendant for
the period mentioned.
Magistrate
Magistrates Court
Form 25
Request for registration of order

Form 25
REQUEST FOR ENFORCEMENT AGAINST

BODY CORPORATE
Summary Procedure Act - Section 188
Registry
.............................................................
Address
...............................................................
Penalty No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Body corporate
Address:
.....................................................................................................
ABN
Charge
Offence:
Section and Act:
..........................................................
..........................................................
Fine or other pecuniary sum

Fine
Costs
Levy (C I C Act)
Reminder notice fee
Paid
Amount now due
Court to which request is directed
............................................
Pursuant to the reciprocal arrangements for the enforcement of fines against bodies corporate, I request that
the attached certified copy of the conviction or order made against this body corporate be registered in your
Court for enforcement within your State.
I certify that the amount outstanding in respect of the conviction or order is the amount now due.
Please issue enforcement proceedings against the body corporate to recover the amount now due by levying
against the goods and chattels of the body corporate.
Please send any money received forthwith to this Registry.
..................................
......................................................................
date
Registrar
Warrant of distress against body corporate registered order
Form 26
Form 26
WARRANT OF DISTRESS
Summary Procedure Act - Section 188
Registry
.............................................................
Address
...............................................................
Penalty No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Body corporate (defendant)
Address:
.....................................................................................................
ABN
..
Charge
Offence:
Section and Act:
..........................................................
..........................................................
Fine or other pecuniary sum

Fine and costs
Warrant fee
Paid
Amount now due
$
$
Date certificate registered
........................................
Date this warrant issued
........................................
Court to which request is directed
............................................
The defendant has been convicted and fined in the Court specified.
Default has been made in payment of the amount due and payable as a result of the Courts order, and the
defendant appears to have property in South Australia.
The Commissioner of Police and each member of the Police Force of the State are directed to give the
defendant the chance to forthwith pay the amount due (plus the costs of issuing and executing this warrant)
and if payment in full is not made, to make distress of the money and goods of the defendant.
If within five clear days following the making of distress (unless the defendant consents in writing to an earlier
sale) the amount due (plus the costs of issuing and executing the warrant) is not paid, then you are to sell the
goods and pay the proceeds of the sale to the Court which issued this warrant. If no distress can be found you
are to certify that to the Court.
......................................................................
Registrar
CONSTABLES RETURN OF WARRANT
Address:
.....................................................................................................
I certify that I have made a diligent search for goods and chattels belonging to the defendant that would be
sufficient, if seize and sold, to satisfy the amount due (plus the costs of issuing and executing the warrant),
and for the reasons set out below, I am unable to do so.
Reason(s) for not being able to execute warrant:
..................................................
................................................................
date
signature
Authority to enter and inspect section 22 Magistrates Court Act
Form 27
Form 27
AUTHORISATION TO ENTER AND INSPECT

(LAND/BUILDING)
Magistrates Court Act 1991 - Section 22
Registry
.............................................................
Address
...............................................................
File No
............................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Case details
Defendant (name):
.....................................................................................................
Description of land/building: .....................................................................................................

Address:
.....................................................................................................
Authorised officer
The authorised officer is authorised to enter the land and/or building and to carry out an inspection
pursuant to an order of the Court.
NOTE:
Any person who refuses or fails without reasonable excuse to produce evidentiary material as required
by the Court to produce commits a contempt of Court.
Court order
..................................
date
.....................................................................
Magistrate/Registrar/Justice
Form 28
Application for intervention order

Form 28
APPLICATION
(INTERVENTION ORDER)
Date Filed:
Intervention Orders (Prevention of Abuse)Act 2009

Section 20
Applicant (Police applicant state rank and number)

Name
Surname
Given name/s
Street
AP Number
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Defendant (Police may provide details separately)

DOB
Name
Surname
Given name/s
dd/mm/yyyy
Street
Address
City/Town/Suburb
State
Postcode
Proposed Protected Person(s)

DOB
Surname
Given name/s
Surname
Given name/s
Surname
Given name/s
Surname
Given name/s
dd/mm/yyyy
DOB
Names
dd/mm/yyyy
DOB
dd/mm/yyyy
DOB
The applicant says that the defendant may commit the following act of abuse:
domestic abuse
non-domestic abuse
dd/mm/yyyy
You must provide details of the following:

Any children who will not be protected persons but who may be affected by the order:
Name
Age
Name
Age
Name
Age
Name
Age
Any relevant Family Law Act order, Childrens Protection Act order or agreement or order for the division of property
under the Family Law Act 1975 (Cth), or the Domestic Partners Property Act 1996 (SA) or a corresponding law of
another jurisdiction, any pending application for such an order, and any other legal proceedings between a person
proposed to be protected by the order and the defendant, of which the applicant is aware.
.............................................
...............................................................
Date
Applicant
TThe applicant seeks the intervention orders on the attached sheet:

TThe applicant will seek a tenancy order:
Yes
Address of premises
No:
(If yes, please give this information)
Term of lease
Name of:
the present tenant(s)
the proposed tenant
Present rent
How much is the bond
Name of landlord or agent

Phone number
Email
The applicant will seek a problem gambling order:
Yes
No:
INTERIM INTERVENTION ORDER TERMS REQUESTED

The defendant must not:
1
assault, threaten, harass or intimidate the protected person(s).
follow or keep the protected person(s) under surveillance.
be within
contact or communicate with the protected person(s) either directly or in any way (including phone, letter,
cards, SMS, messages, E-mail, Facsimile etc).
enter or remain within

metres of the boundary of the protected person(s) place of residence, place
of employment or any other place at which the protected person(s) is staying or working.
damage or interfere with the premises where the protected person(s) is staying, residing or is employed.
damage or take possession of personal property belonging to the protected person(s) and the following
specified property:
enter or be within
enter or be within
metres of the boundary of any education or care facility attended by the
protected person(s) and at the moment the protected person(s) are attending these facilities at
10
be in possession of the following weapon(s) or article(s):
11
publish on the internet, by E-mail, SMS or other electronic means any material about the protected
person(s).
12
cause, allow or encourage another person to do anything forbidden by this order.
13
other:
metres of the protected person(s).
metres of the boundary of the following locations:
(clause 14 is permission to remove property and is a matter for the court)

The defendant must:
15
vacate the premises at

forthwith upon service of this order
and not return to those premises unless this term is varied or dismissed by the Court.
Form 28A
Complaint (paedophile restraining order)

Form 28A
date filed
COMPLAINT
(PAEDOPHILE RESTRAINING ORDER)

Section 99AA
Complainant
surname
reference
given name
Complainants
street
telephone
facsimile
city/town/suburb
state
postcode
e-mail address
Defendant
surname
given name
dd/mm/yy
street
number
licence
city/town/suburb
state
postcode
The complainant says that the defendant:
Child Sex Offenders Registration Act 2006has been found loitering near children on at least 2
occasions and there is reason to think that the defendant may, unless restrained, again so loiter; or
has been found using the internet to communicate with children or persons whom the defendant
believed to be children on at least 2 occasions and there is reason to think that the defendant may,
unless restrained, again so use the internet; and
that the making of the order is appropriate in the circumstances.
The complainant seeks an order restraining the defendant from:-

Form 28B
Complaint (child protection restraining order)

Form 28B
date filed
COMPLAINT
(CHILD PROTECTION RESTRAINING
ORDER)

Section 99AAC
Complainant
surname
relationship to child
Complainants reference/
given name
street
telephone
facsimile
city/town/suburb
state
postcode
e-mail address
Defendant
surname
given name
dd/mmm/yy
street
number
licence
city/town/suburb
state
postcode
Child for whose benefit order is sought

:..................................................... , ................................................
surname
dd/mmm/yy
..................................
given name
The complainant says that:
the defendant is an adult who is, or has been, residing with the above-named child who is
under the age of 17 years of whom the defendant is not a guardian;
AND
the defendant and the above-named child are, or have been, residing at premises other
than premises in which a guardian of the child resides;
AND
the defendant or another person who resides at, or frequents, premises at which the
defendant and the above-named child reside or have resided-
has, within the preceding 10 years, been convicted of the prescribed

offence(s) of ...; or
is, or has at any time been, subject to a restraining order under section
99AAC;
OR
as a consequence of the above-mentioned childs contact or residence with the defendant, the
child is at risk of
sexual, physical, psychological, or emotional abuse or neglect; or
engaging in, or being exposed to, conduct that is an offence under

Part 5 of the Controlled Substances Act 1984;

The complainant seeks an order restraining the defendant from:-
Date
Witness
Complainant
Form 29
Interim intervention summons order

Form 29
INTERIM INTERVENTION ORDER and SUMMONS


Section 21
This document must be served on the defendant personally

AP
Number
File
No
Registry
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Defendant
DOB
Name
Surname
Given name/s
Surname
Given name/s
dd/m
m/yy
yy
Applicant
Name
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Protected Person(s)
DOB
Surname
dd/m
m/yy
yy
Given name/s
DOB
Surname
dd/m
m/yy
yy
Given name/s
Name(s)
DOB
Surname
dd/m
m/yy
yy
Given name/s
DOB
Surname
Given name/s
dd/m
m/yy
yy
Date order made:

The Court has heard an application in your absence and is satisfied that there is a reasonable
apprehension that you may commit an act of abuse and has made an order against you.
Intervention order made:
1
be within
contact or communicate with the protected person(s) either directly or in any way (including phone,
letter, cards, SMS, messages, E-mail, Facsimile etc).

metres of the boundary of the protected person(s) place of residence,
place of employment or any other place at which the protected person(s) is staying or working.
damage or interfere with the premises where the protected person(s) is staying, residing or is
employed.
specified property:
enter or be within
enter or be within
10
11
person(s).
12
13
other:
The defendant is:

14
permitted to attend at the protected person(s) residence once in the presence of and at a time
organised by a police officer to collect personal property not affected by this order.
The defendant must:

15

forthwith upon service of this order and
not return to those premises unless this term is varied or dismissed by the Court.
16
to contact the nominee of the intervention program manager at phone number

and make and attend an appointment for assessment and if assessed as suitable undertake any
intervention program that is appropriate for the defendant.
Notwithstanding the other terms of this order contact is permitted:

17
for access to children or at a meeting or hearing ordered by a court exercising jurisdiction under the
Family Law Act 1975 (Cth), the Childrens Protection Act 1993 (SA) at a relevant hearing at the Social
Security Appeals Tribunal or a court or tribunal hearing at which both a protected person and the
defendant are required to attend.
18
by a solicitor or police
19
other:
Firearms orders (must be made):
20
any firearm in the possession of the defendant and any licence or permit held by the defendant
authorising possession of a fire arm must be surrendered to the Registrar of Firearms forthwith.
21
for so long as this intervention order remains in force, any licence or permit held by the defendant
authorising possession of a firearm is suspended and the defendant is disqualified from holding or
obtaining a licence or permit authorising possession of a firearm including in the course of his or her
employment.
22
Other
Hearing
details
Registry
Date
Address
Time
Telephone
Facsimile
Email Address
............................................
..............................................................
Date
MAGISTRATES COURT
IMPORTANT NOTICE TO DEFENDANT
Non-compliance with the order renders you liable to a term of imprisonment not exceeding 2 years
If you do not appear, an order may be made in your absence
Upon registration, this order is also enforceable in other States and Territories
A copy of any evidence that was relied on to make the order may be obtained from the Registry
am/pm
Proof of Service
Name of deponent:
Address of deponent:
Name of person served:
Address at which service effected:
Date service effected:
Time of day: Between
am/pm and
am/pm
I certify that I served the attached document on the defendant personally.

Certified this
day of
20
.................................................................................
Note include instructions to the police officer
serving this order
Note Form 43 Multilingual Notice must be
served with this Interim Order
Form 29A
Summons (paedophile restraining order)

Form 29A
Court Use
SUMMONS
(PAEDOPHILE RESTRAINING ORDER)

Section 99AA
date filed
Registry
.................................................
File No
............................................
Address
...............................................................
Date complaint laid .................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mm/yy
Address
..................................
given name
......................................................................................................
..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ..............................................
street
..................................
telephone
facsimile
.................................................................................................
city/town/suburb
The complainant says that the defendant:
state
postcode
..........................................
e-mail address
is required to comply with the reporting obligations imposed by Part 3 of the Child Sex Offenders
Registration Act 2006; or
has been found loitering near children on at least 2 occasions and there is reason to think that the
defendant may, unless restrained, again so loiter; or
has been found using the internet to communicate with children or persons whom the defendant
believed to be children on at least 2 occasions and there is reason to think that the defendant may,
unless restrained, again so use the internet; and

A complaint has been laid seeking an order restraining the defendant from:-
Hearing details
Registry.......................................................
Date....................................
Address......................................................
Time ..........................am/pm
...........................
MAGISTRATES COURT
If you do not appear a Restraining Order may be made in your absence.
A copy of the complaint and any evidence that has been tendered to the Court may be obtained from the
Registry.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by leaving a copy at the place of business with a person apparently employed there
and not less than 16 years of age;
by prepaid post.

...........................................................................................
) ..............................................
of ................. 20.....
Form 29B
Summons (child protection restraining order)

Form 29B
Court Use
SUMMONS
(CHILD PROTECTION RESTRAINING
ORDER)

Section 99AAC
date filed
Registry
.................................................
File No
............................................
Address
...............................................................
Date complaint laid .................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Name: .............................................. , ................................................
DOB
..................................
......................................................................................................
..................................
surname
dd/mmm/yy
Address
given name
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:................................................ , ..............................................
surname
Address:
..........................................
street
..........................................
Complainants reference/ relationship to child
given name
..............................................
..................................
telephone
facsimile
...........................................................................................................................................
city/town/suburb
state
postcode
e-mail address
Child for whose benefit order is sought

Name:..................................................... , ................................................
surname
The complainant says that:
given name
DOB
..................................
dd/mmm/yy
the defendant is an adult who is, or has been, residing with the above-named child who is under
the age of 17 years of whom the defendant is not a guardian;
AND
the defendant and the above-named child are, or have been, residing at premises other than
premises in which a guardian of the child resides;
AND
the defendant or another person who resides at, or frequents, premises at which the defendant
and the above-named child reside or have resided-

99AAC;
OR
child is at risk of

engaging in, or being exposed to, conduct that is an offence under Part 5 of
the Controlled Substances Act 1984;
AND
(Details of the hearing are on the next page)
A complaint has been laid seeking an order restraining the defendant from:-
Hearing details
Registry.......................................................
Date....................................
Address......................................................
Time ..........................am/pm
...........................
MAGISTRATES COURT
If you do not appear a Restraining Order may be made in your absence.
A copy of the complaint and any evidence that has been tendered to the Court may be obtained from
the Registry.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................
) ..............................................
of ................. 20.....
Form 30
Intervention order
Form 30
INTERVENTION ORDER

Section 23

AP Number
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Defendant
DOB
Name
Surname
Given name/s
Surname
Given name/s
dd/mm/yyy
y
Applicant
Name
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Protected Person(s)
DOB
Surname
dd/mm/yyy
y
Given name/s
DOB
Surname
dd/mm/yyy
y
Given name/s
Name(s)
DOB
Surname
dd/mm/yyy
y
Given name/s
DOB
Surname
Given name/s
dd/mm/yyy
y
Intervention order made:

Confirm interim intervention order (s 23(1)(a))
Issue intervention order in substitution for interim intervention order (s 23(1)(b))
Details of intervention order:

1
be within
contact or communicate with the protected person(s) either directly or in any way (including phone,
letter, cards, SMS, messages, E-mail, Facsimile etc).

metres of the boundary of the protected person(s) place of residence,
place of employment or any other place at which the protected person(s) is staying or working.
damage or interfere with the premises where the protected person(s) is staying, residing or is employed.
specified property:
enter or be within
enter or be within
10
11
person(s).
12
13
other:
The defendant is:

14
permitted to attend at the protected person(s) residence once in the presence of and at a time organised
by a police officer to collect personal property not affected by this order.
The defendant must:

15

forthwith upon service of this order
and not return to those premises unless this term is varied or dismissed by the Court.
16
to contact the nominee of the intervention program manager at phone number

and make and attend an appointment for assessment and if assessed as suitable undertake any
intervention program that is appropriate for the defendant.
Notwithstanding the other terms of this order contact is permitted:

17
for access to children or at a meeting or hearing ordered by a court exercising jurisdiction under the
Family Law Act 1975 (Cth), the Childrens Protection Act 1993 (SA), at a relevant hearing at the Social
Security Appeals Tribunal or a court or tribunal hearing at which both a protected person and the
defendant are required to attend.
18
by a solicitor or police
19
other:
Firearms orders (for exceptions see section 14(2)):

20
any firearm in the possession of the defendant and any licence or permit held by the defendant
authorising possession of a fire arm must be surrendered to the Registrar of Firearms forthwith.
21
for so long as this intervention order remains in force, any licence or permit held by the defendant
authorising possession of a firearm is suspended and the defendant is disqualified from holding or
obtaining a licence or permit authorising possession of a firearm including in the course of his or her
employment.
22
other
............................................
..............................................................
Date
MAGISTRATES COURT
Non-compliance with the order renders you liable to a term of imprisonment not exceeding 2 years
Upon registration, this order is also enforceable in other States and Territories
You cannot apply to the court to vary this order for 12 months or such longer period as the court may have
ordered.
Proof of Service (only required for an order made under s 23(1)(b))

Name of deponent:
Time of day: Between
am/pm and
am/pm

Certified this
day of
20
Note include instructions to the police officer serving this order
Note Form 43 Multilingual Notice must be served with this order
.................................................................................
Form 31
Application for variation or revocation of intervention order

Form 31
Court Use
Date Filed:
APPLICATION FOR VARIATION OR

REVOCATION OF INTERVENTION
ORDER

Section 26

Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
State
Postcode
Email Address
Applicant
Name
Surname
Given name/s
AP Number
Telephone
Facsimile
Address
Street
City/Town/Suburb
State
Postcode
Email Address
Defendant
Name
Surname
DOB
Given name/s
dd/mm/yyyy
The applicant seeks to have the intervention order made on file number dated :
revoked varied
details of variation sought:
a related tenancy order will need to be varied
a related problem gambling order will need to be varied
............................................. ..............................................................
Date APPLICANT
Hearing details
Registry
Date
Address
Telephone
Facsimile
Email Address
Time am/pm
............................................ ..............................................................
Date MAGISTRATES COURT
IMPORTANT NOTICE TO DEFENDANT AND APPLICANT
If you do not appear, an order may be made in your absence.
Proof of Service
Name of deponent:
Time of day: Between am/pm and am/pm
Certified this day of 20 .................................................................................
Form 31A
Restraining order (paedophile) and summons (s 99A and 99C)

Form 31A
Court Use
RESTRAINING ORDER
(PAEDOPHILE) and SUMMONS

Sections 99AA and 99C(2)
date filed
This document must be served on the defendant personally.

Registry
.................................................
File No
............................................
Address
................................................................................................................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mm/yy
Address
..................................
given name
......................................................................................................
..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ..............................................
street
..................................
telephone
facsimile
.................................................................................................
city/town/suburb
Date order made:

The Court was satisfied that the defendant:
state
postcode
..........................................
e-mail address
is required to comply with the reporting obligations imposed by Part 3 of the Child Sex Offenders
Registration Act 2006; or
has been found loitering near children on at least 2 occasions and there is good reason to think that the
defendant may, unless restrained, again so loiter or use the internet; or
has been found using the internet to communicate with children or persons whom the defendant believed
to be children on at least 2 occasions and there is reason to think that the defendant may, unless
restrained, again so use the internet;
and that the making of the order was appropriate in the circumstances.
Order made:-
Hearing details
Registry.................................................
Date....................................
Address.................................................
Time .................................am/pm
..................
...........................
Date
MAGISTRATES COURT
Non-compliance with a served order renders you liable to a term of imprisonment not exceeding 2 years.
If you do not appear, the order will be confirmed.
Upon registration, this order is also enforceable in other States and Territories.
A copy of any evidence that was relied on to make the order may be obtained from the Registry.
PROOF OF SERVICE
Name of deponent:.....................................................................
I certify that I served the attached document upon the defendant personally.
) ..............................................
of ................. 20......
Form 31B
Restraining order (child protection) and summons

Form 31B
Court Use
RESTRAINING ORDER
(CHILD PROTECTION) and SUMMONS

Section 99AAC and 99C(2)
date filed

Registry
.................................................
File No
Address
............................................................... ........................................................................
..........................................
............................................
telephone
facsimile
............................................
..........................................
..
e-mail address
Defendant
Name: .............................................. , ................................................
DOB
..................................
......................................................................................................
..................................
surname
dd/mmm/yy
Address:
given name
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:................................................. , ..............................................
surname
reference/ relationship to child
Address
.........................................
street
..........................................
Complainants
given name
.............................................. ..................................
telephone
facsimile
......................................................................................................................................
city/town/suburb
state
postcode
e-mail address
Child for whose benefit order is made

Name:..................................................... , ................................................
surname
Date order made:

The Court was satisfied that:
given name
DOB
..................................
dd/mmm/yy
the defendant is an adult who is, or has been, residing with the above-named child who is
under the age of 17 years of whom the defendant is not a guardian;
AND
the defendant and the above-named child are, or have been, residing at premises other than
premises in which a guardian of the child resides;
AND
the defendant or another person who resides at, or frequents, premises at which the
defendant and the above-named child reside or have resided-

99AAC;
OR
child is at risk of

engaging in, or being exposed to, conduct that is an offence under Part 5
of the Controlled Substances Act 1984;
AND
Order made:-
Hearing details
Registry.......................................................
Date....................................
Address......................................................
Time ..........................am/pm
..................
...........................
Date
MAGISTRATES COURT
Non-compliance with a served order renders you liable to a term of imprisonment not exceeding 2
years.
This order will expire when the above-named child reaches the age of 17 years or, if an earlier time is
specified in the order, at that earlier time.
If you do not appear, the order will be confirmed.
A copy of any evidence that was relied on to make the order may be obtained from the Registry.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................
) ..............................................
of ................. 20.....
Form 31C
Restraining order (Paedophile)

Form 31C
Court Use
Date Filed:
RESTRAINING ORDER
(PAEDOPHILE)
Summary Procedures Act 1921

Section 99AA

Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
Postcode
State
Email Address
Date complaint laid
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Given name/s
Telephone
Facsimile
Address
Street
City/Town/Suburb
Complainant
Name
Surname
Address
Street
City/Town/Suburb
State
Postcode
Email Address
The defendant is restrained in the following terms:
............................................ ..............................................................
Date
MAGISTRATES COURT
Non-compliance with a served order renders you liable to a term of imprisonment not exceeding 2 years
ordered.
Proof of Service
Name of deponent:
Certified this day of 20 .................................................................................
Form 31D
Restraining order (child protection)

Form 31D
Court Use
Date Filed:
RESTRAINING ORDER
(CHILD PROTECTION)
Summary Procedures Act 1921

Section 99AAC

Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
Postcode
State
Email Address
Date complaint laid
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Given name/s
Address
Street
City/Town/Suburb
Complainant
Name
Surname
Address
Street
City/Town/Suburb
Telephone
Facsimile
State
Postcode
Email Address
The defendant is restrained in the following terms:
............................................ ..............................................................
Date
MAGISTRATES COURT

Non-compliance with a served order renders you liable to a term of imprisonment not exceeding 2 years
ordered.
Proof of Service
Name of deponent:
Certified this day of
20 .........................
Form 32
Application to revoke restraining order

Form 32
APPLICATION TO VARY OR
REVOKE RESTRAINING ORDER
Court Use


Sections 99F
Registry
.................................................
Address
...............................................................
date filed
File No
............................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
Address
..................................
given name
......................................................................................................
..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ..............................................
street
..................................
telephone
facsimile
.................................................................................................
..........................................
city/town/suburb
state
postcode
e-mail address
Application made by:

Complainant;
Person for whose benefit the order way made; or
Defendant
(If this application is taken out by the Defendant, you must get leave from the Court before this application
can be made.
To do this you must show that there has been a substantial change in the relevant circumstances since the
order was made or last varied, and an affidavit must be attached setting out details of the change.)
Details of order which is sought to be varied or revoked:
Variation sought:
.............................................................
(Applicants signature)
Hearing details
.......................................
telephone
Registry.......................................................
Date....................................
Address......................................................
Time
.................................am/pm
.................................................
facsimile
.......................................
e-mail address
...........................
MAGISTRATES COURT
IMPORTANT NOTICE TO DEFENDANT AND COMPLAINANT

If you do not appear an order may be made in your absence.
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................

of ................. 200...
) ..............................................
)
Form 33
Restraining order as varied

Form 33
Court Use
RESTRAINING ORDER
(as varied)
date filed

Sections 99F
Registry
.................................................
File No
Address
...............................................................
............................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
Address
..................................
given name
......................................................................................................
.................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Complainant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ................................................................................
street
telephone
.................................................................................................
city/town/suburb
Date of original order
state
Original order:
Date of variation of order

Order as varied:
..
postcode
facsimile
..........................................
e-mail address
..................
Date
...........................
MAGISTRATES COURT
Non-compliance with a served order renders you liable to a term of imprisonment not exceeding 2 years.
A copy of any evidence that was relied on to vary the order may be obtained from the Registry.
PROOF OF SERVICE
Name of deponent:.....................................................................
I certify that I served the attached document on the defendant personally

of ................. 200...
) ..............................................
)
Form 34
Order revoking restraining order

Form 34
Court Use
date filed
ORDER REVOKING
RESTRAINING ORDER

Sections 99F
Registry .................................................
Address ...............................................................
..........................................
............................................
telephone
facsimile
File No ............................................
............................................
e-mail address
Defendant
Name:..................................................... , ................................................ DOB ..................................
surname given name dd/mmm/yy
Address ...................................................................................................... ..................................

street licence number
..................................................................................................
city/town/suburb state postcode
Complainant
Name:.................................................... , .............................................. ..........................................
surname given name Complainants reference
Address .............................................. .............................................. ..................................

street telephone facsimile
................................................................................................. ..........................................
city/town/suburb state postcode e-mail address
Date of original order ..

Original order:
Date order revoked:..
..................
Date
...........................
MAGISTRATES COURT
PROOF OF SERVICE
Name of deponent:.....................................................................
personally;
by leaving a copy at the last (or most usual) place of abode with a person apparently residing there
by prepaid post.
any other method permitted by the Rules specify ...........................................................
Certified this....... day ) .............................................. of ................. 200... )
Form 35
Notice of not guilty hearing

Form 35
Court Use
NOTICE OF HEARING
date filed
Summary Procedure Act, 1921 - Section 57A(7a)
Registry
.............................................................
Address
...............................................................
File No
............................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Complainant
Name:.................................................... , ..............................................
surname
Address
..........................................
given name
.............................................. ..............................................
street
..................................
telephone
facsimile
.................................................................................................
city/town/suburb
state
..........................................
postcode
e-mail address
Defendant
Name:..................................................... , ................................................ DOB
surname
dd/mmm/yy
Address
..................................
given name
......................................................................................................
..................................
street
licence number
..................................................................................................
city/town/suburb
state
postcode
Offence details
Hearing details
.......................................
Registry.......................................................
Date....................................
Address......................................................
Time
.................................am/pm
.................................................
telephone
facsimile
........................................
e-mail address
The date mentioned is set for the trial of the charges against you
You need to attend of that day with all witnesses who you wish to give evidence in your defence.
If you do not attend the matter may be heard and finalised in your absence.
........................................
Date
...........................
MAGISTRATES COURT
PROOF OF SERVICE
Name of deponent:.....................................................................

personally;
by prepaid post.

...........................................................................................

of ................. 200...
) ..............................................
)
Form 36
Problem gambling order

Form 36
PROBLEM GAMBLING ORDER


Registry
Address
Street
City/Town/Suburb
Section 24 and the Problem Gambling Family Protection Orders Act 2004
File No
Telephone
State
Facsimile
Postcode
Email Address
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
An intervention order has been made against the defendant and there is a reasonable apprehension
of harm to family members because of problem gambling and this order is appropriate in the
circumstances: (note that if this a variation or revocation of an existing order details of that order
must be included)
Interim Attachment Order
Insert name: (the third party) of
has money owing or accruing to the defendant (including money in an ADI account) and it is ordered that this
money be retained until further court order.
............................................
..............................................................
Date
MAGISTRATES COURT
Proof of Service
Name of deponent:
Certified this day
of 20 .................................................................................
Form 37
Notice of problem gambling attachment order

Form 37
NOTICE OF PROBLEM GAMBLING ATTACHMENT ORDER

Registry
Address
Street
City/Town/Suburb

Section 24(3) and the Problem Gambling Family Protection Orders Act 2004
File No
Telephone
State
Facsimile
Postcode
Defendant
Name
Email Address
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Third party to whom this order is directed

Name
Surname
Given name/s
Address
Street
City/Town/Suburb
State
Postcode
The third party has money owing or accruing to the defendant (including money in an ADI account) and it has
been ordered that this money be retained until further court order. At the next hearing date the court will
decide whether this money should be paid to satisfy a debt owed by the defendant or otherwise applied as
ordered by the court.
If you do not comply with this order, you will become personally liable for payment to the beneficiaries of the amount
unpaid in breach of the order
rty is an employer of the defendant, you will be guilty of an offence if you, because of the order:
-dismiss the employee,
- injure the employee in employment, or
- alter the employees position to the employees prejudice.
Maximum Penalty $10 000
Compensation for expenses incurred by the third party may be ordered by the court.
Hearing details
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
............................................
..............................................................
Date
MAGISTRATES COURT
Proof of Service
Name of deponent:
Certified this day
of 20 ..................................................................................
Form 38
Notice of intention to assign tenancy

Form 38
NOTICE OF INTENTION TO ASSIGN TENANCY

Registry
Address

Section 25
File No
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Defendant
Name
Email Address
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Landlord to whom this order is directed

Name
Surname
Given name/s
Address
Street
City/Town/Suburb
State
Postcode
State
Postcode
Premises
Address of Premises
Street
City/Town/Suburb
Tenant
Surname
Given name/s
Proposed Tenant
Surname
Given name/s
Rent:
Bond:
An intervention order has been made against the defendant who has been prohibited from being at the
premises and the court has been asked to make an order assigning the defendants tenancy to (insert name of
protected person) in accordance with section 25 of the Act which is attached. You can attend the hearing
notified below and be heard as to whether the order should be made. If you do not attend the order may be
made in your absence.
Hearing details
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
............................................
Date
..............................................................
MAGISTRATES COURT
Proof of Service
Name of deponent:
I certify that I served the attached document on the landlord by the following means.
Certified this day
of 20 .................................................................................
INTERVENTION ORDERS
(PREVENTION OF ABUSE) ACT 2009
25Tenancy order
(1)
If
(a)
the Court confirms an interim intervention order as an intervention order against a
defendant
or issues an intervention order against a defendant in substitution for an interim
intervention order; and
(b)
the intervention order prohibits the defendant from being on premises at which a protected
person resides; and
(c)
the defendant and protected person previously resided together on the premises; and
(d)
the premises are subject to a tenancy agreement to which the defendant is a party,
the Court may make an order (a tenancy order) that the defendant will be taken to have
assigned the defendant's interest in the tenancy agreement to a specified person or persons
with the landlord's consent.
(2)
the
However, a tenancy order may only be made if the Court is satisfied that the assignee consents to
assignment and
(a)
and
(b)
(c)
in a case where the landlord is a registered housing co-operativethe assignee is eligible for
membership of the co-operative and willing to accept the responsibilities of membership;
in a case where the landlord is the South Australian Housing Trust or a subsidiary of the
South Australian Housing Trustthe assignee meets the eligibility requirements of the Trust;
and
in any casethe assignee could reasonably be expected to comply with the obligations under
the tenancy agreement,
(so that it would be unreasonable for the landlord to withhold consent to the assignment).
(3)
A tenancy order takes effect on the day on which it is made or on such later day as is specified in the
order.
(4)
If a tenancy order is made

(a)
under
before
(b)
(c)
(5)
the effect of the assignment is that the assignee is substituted for the assignor as tenant
the tenancy agreement (but the assignor remains responsible for liabilities that accrued
the date of the assignment); and
the assignee is liable to indemnify the assignor for liabilities incurred by the assignor to the
landlord because of a breach of the tenancy agreement by the assignee; and
an amount paid by the assignor and held by way of security for the performance of
obligations under the tenancy agreement will (unless the parties agree to the contrary)
continue to be held as security for the proper performance by the assignee of obligations
under the tenancy agreement.
The Registrar must give a copy of a tenancy order to

(a)
(b)
(c)
(d)
(e)
the protected person; and

the defendant; and
the landlord; and
if the assignee is not the protected personthe assignee; and
the Registrar of the Residential Tenancies Tribunal.
Form 39
Tenancy Order
Form 39
TENANCY ORDER

Section 25
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Landlord
Surname/Company Name
Facsimile
Postcode
Email Address
DOB
Given name/s/ACN Number
dd/mm/yyyy
State
Postcode
State
Postcode
Address
Street
City/Town/Suburb
Premises
Street
City/Town/Suburb
Tenant/ Assignor
Surname
Given name/s
Assignee
Surname
Given name/s
Rent
Bond
An intervention order has been made against the tenants/assignor and the requirements of s 25 have been
satisfied so that the court now orders that the interest of the tenants/assignor in the tenancy at the above
premises is assigned to the assignee on the date specified and from that date the assignee is substituted for
the assignor as tenant under the tenancy agreement (but the assignor remains responsible for liabilities that
accrued before the date of the assignment) and the assignee is liable to indemnify the assignor for liabilities
incurred by the assignor to the landlord because of a breach of the tenancy agreement by the assignee. The
security bond will (unless the parties agree to the contrary) continue to be held as security for the proper
performance by the assignee of obligations under the tenancy agreement.
Where it is required the assignee will accept the responsibilities of membership of a registered housing
cooperative.
The assignee agrees to be bound by and comply with the obligations under the tenancy agreement.
Specified Date
Rent
Bond
............................................ ..............................................................
Date
MAGISTRATES COURT
Where this order is made in the absence of the landlord it must be served on the landlord.
Form 40
Application to vary or revoke a problem gambling order or tenancy order

Form 40
Court Use
APPLICATION TO VARY OR REVOKE A

PROBLEM GAMBLING ORDER OR
TENANCY ORDER
Date Filed:

Intervention Orders (Prevention of Abuse) Act 2009

Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcod
e
Email Address
Other Party Affected

Name
Surname
DOB
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
The applicant wishes to vary or revoke the following:

a tenancy order
a problem gambling order
File Number
Date of Order
Order sought
This application will be listed for directions as to service, parties to be joined, and generally.
Registry
Date
Hearing details
Address
Telephone
Facsimile
Time am/pm
Email Address
............................................ ..............................................................
Date
MAGISTRATES COURT
Form 41
Request to register foreign intervention order

Form 41
Court Use
Date Filed:
REQUEST TO REGISTER
FOREIGN INTERVENTION
ORDER
Intervention Orders (Prevention of

Abuse)Act 2009
Section 30
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Date foreign order made:

Date foreign order expires:
A certified copy of the foreign order is attached. Please register the order in the Court.
The reasons for requesting registration of the foreign order in South Australia:
Do you wish for the order to be served on the defendant? Yes No
If not, why not?
Do you wish for the order to be varied? Yes No
If yes, please specify the terms you wish to vary?
Is an affidavit in Form 45 attached outlining the reasons for the variation? Yes No
IMPORTANT NOTICE
Please note if you apply to vary the order the defendant will be given notice of the application and will be given a right
to be heard.
............................................ ..............................................................
Date APPLICANT
Hearing details
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
...........................................................................................................
* Interstate Registrar
* Member of the South Australian Police Force
*(strike out whichever is not applicable) * A person for whose benefit the foreign order was made
The Registrar must obtain a certified copy of the foreign order and details of the next hearing date in the other
jurisdiction, where applicable.
Form 41
Request to register foreign intervention order

Form 41
Court Use
Date Filed:
REQUEST TO REGISTER FOREIGN

INTERVENTION ORDER

Section 30
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
Facsimile
Postcode
State
Email Address
Date foreign order made:

Date foreign order expires:
A certified copy of the foreign order is attached. Please register the order in the Court.
The reasons for requesting registration of the foreign order in South Australia:
Do you wish for the order to be served on the defendant? Yes No
If not, why not?
Do you wish for the order to be varied? Yes No
If yes, please specify the terms you wish to vary?
Is an affidavit in Form 45 attached outlining the reasons for the variation? Yes No
IMPORTANT NOTICE Please note if you apply to vary the order the defendant will be given notice of the
application and will be given a right to be heard.
............................................ ..............................................................
Date
Hearing details
APPLICANT
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
...........................................................................................................
* Interstate Registrar
* Member of the South Australian Police Force
*(strike out whichever is not applicable) * A person for whose benefit the foreign order was made
The Registrar must obtain a certified copy of the foreign order and details of the next hearing date in the other
jurisdiction, where applicable.
Form 42
Notice of registration of foreign intervention order

Form 42
NOTICE OF REGISTRATION OF
FOREIGN INTERVENTION ORDER

Section 30

Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
State
Postcode
Email Address
Defendant
Name
Surname
DOB
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Date foreign order registered:

A certified copy of the foreign order that has been registered is attached.
That order has been adapted for application in this State, and now restrains you in the following terms:
............................................ ..............................................................
Non-compliance with the order renders you liable to a term of imprisonment not exceeding 2 years.
Proof of Service
Name of deponent:
Certified this day
of 20 .................................................................................
Form 43
Multilingual notice
Form 43
English
Important Information
THIS INTERVENTION ORDER PROHIBITS YOU FROM COMMITTING AN ACT OF ABUSE

AGAINST THE PROTECTED PERSON(S) NAMED IN THE ORDER.
IT IS AN OFFENCE TO DISOBEY ANY TERM OF AN INTERVENTION ORDER.
THE PENALTY FOR DISOBEYING THE ORDER CAN BE IMPRISONMENT FOR UP TO 2 YEARS.
A PROTECTED PERSON CANNOT GIVE PERMISSION TO DISOBEY THE ORDER.
Legal Advice: call the Legal Services Commission 1300 366 424 9.00 am 4.30 pm Mon-Fri
Arabic
43
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1300 366 :
: 424
9 4:30
.
Chinese
Form 43
1300 366 4249:004:30

Croatian
Vana obavijest
Formular 43
OVA NAREDBA ZA INTERVENCIJU VAS SPREAVA DA POINITE AKT ZLOSTAVLJANJA NAD

ZATIENOM OSOBOM ILI OSOBAMA KOJE SU IMENOVANE U NAREDBI.
NE PRIDRAVANJE BILO KOJE ODREDBE OVE NAREDBE ZA INTERVENCIJU SMATRA SE KRIVINIM DJELOM.
KAZNA ZA NE PRIDRAVANJE NAREDBE MOE BITI ZATVORSKI PRITVOR U PERIODU DO DVIJE GODINE.
ZATIENA OSOBA NE MOE DATI DOZVOLU DA SE ODREDBA MOE PREKRITI.
Pravni savjet: nazovite Legal Services Commission (Komisija za pravne usluge)
na broj 1300 366 424 od 9.00 do 16.30 od ponedjeljka do petka.
Dinka
Lk Thiekiic
Form 43
YE YK N YT-THN KEE YN PN BA YAA LUI RAAN GL TU RIN N ATHR DE YKIC.

KEE AWC BA GUT DE MN C TU DE YK N YT-THNIC DHOKU.
WI T DHO YK KU KA LU B YA MNY LGUT N RUN KAA 2.
RAAN GL KA C LU B PL B YK DHOKU.
JIM N L:- CL KMCON DE LOI KE L 1300 366 424.
9:00 N RIAL- 4.30 THI, N KL DE TK - KL DE DHIC.
Greek
43

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.
:
(Legal Services Commission)
1300 366 424 9.00 4.30 .
Italian
Informazioni importanti
Modulo 43
QUESTO ORDINE DINTERVENTO LE PROIBISCE DI COMMETTERE UN ATTO

ABUSIVO CONTRO LA PERSONA(E) NOMINATA IN QUESTO ORDINE.
UN REATO CONTRAVVENIRE QUALUNQUE CONDIZIONE
DI UN ORDINE DINTERVENTO.
LA PENA PER CONTRAVVENIRE LORDINE PU ESSERE UN PERIODO
DI FINO A 2 ANNI IN CARCERE.
LA PERSONA PROTETTA NON PU DARE IL PERMESSO PER
CONTRAVVENIRE LORDINE.
Assistenza Legale: chiami la Commissione per i Servizi Legali 1300 366 424
9.00 am 4.30 pm luned a venerd
Nepali
.
Polish
Wana Informacja
Formularz 43
TEN NAKAZ INTERWENCYJNY ZAKAZUJE CI POPENIENIA AKTU PRZEMOCY WOBEC

CHRONIONYCH OSB WYMIENIONYCH W TYM NAKAZIE.
NIEZASTOSOWANIE SI DO KTREGOKOLWIEK Z WARUNKW NAKAZU
INTERWENCYJNEGO JEST PRZESTPSTWEM.
KAR ZA NIEZASTOSOWANIE SI DO NAKAZU MOE BY POZBAWIENIE WOLNOCI DO 2 LAT.
CHRONIONA OSOBA NIE MOE WYRAZI ZGODY NA NIEZASTOSOWANIE SI DO NAKAZU.
Porady prawne: zadzwo do Komisji Usug Prawnych pod numer 1300 366 424
od 09.00 do 16.30 od poniedziaku do pitku
Serbian
43

/
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.

.
: (Legal
Services Commission)
1300 366 424 9.00 16.30 .
Swahili
Habari muhimu
Form 43
AMRI HII KUKINGA INAKUZUIA WEWE KUFANYA TENDO LA UNYANYASAJI DHIDI YA MTU
ANAYELINDWA MWENYE JINA LAKE KWENYE MASHTAKA.
NI KOSA KUSHIDWA KUTII AMRI YOYOTE YA KUKINGA.
HUKUMU YA KUSHIDWA KUTII AMRI INAWEZA KUWA KIFUNGO CHA HADI MIAKA 2.
MTU ANAYELIDWA HANA UWEZA WA KUTOA RUHUSA YA KUTOTII AMRI HUSIKA
Ushauri wa Kisheria: Pigia Tume ya Huduma za Kisheria 1300 366 424, 3:00-10:30 Jumatatu-Ijumaa
Vietnamese
Thng Tin Quan Trng
Mu 43
PHP LNH CAN THIP NY CM QU V C HNH NG LM DNG I VI (NHNG)

NGI C BO V C TN TRONG PHP LNH NY.
KHNG TUN TH BT C IU KHON NO CA MT PHP LNH CAN THIP L MT HNH VI PHM PHP
HNH PHT I VI HNH VI BT TUN PHP LNH C TH L T TI 2 NM.
NGI C PHP LNH BO V KHNG TH CH O PHP NGI KHC BT TUN PHP LNH NY.
C Vn Php L: hy gi in thoi cho Hi ng Cc Dch V Php L (Legal Services Commission)
1300 366 424 t 9 gi 00 sng n 4 gi 30 chiu t Th Hai n Th Su.
Form 44
Application for extension of period of detention

Form 44
APPLICATION FOR EXTENSION

OF PERIOD OF DETENTION
Court Use
Date Filed:

Intervention Orders (Prevention of Abuse)Act

2009
Section 35(2)
Applicant (state rank and number)

Name
Surname
Given name/s
Stationed at
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Defendant
Name
Surname
DOB
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Details of intervention order:

Date intervention order made
AP number
Person(s) protected
Time and date of apprehension:

Time Date
Grounds of application:
Order:
I am satisfied that it is necessary to detain the defendant to prevent the immediate commission of abuse
against a person protected by the order, or to enable measures here specified for the protection of the
person specified in the order. I authorise the applicant to detain the person for the following period: (which
must not exceed an aggregate of 24 hours):
Measures specified
Period of detention
............................................
Date
..............................................................
MAGISTRATES
Form 45
Affidavit (intervention order)

Form 45
Court Use
Date Filed:
AFFIDAVIT
(INTERVENTION ORDER)

Registry
File No
Applicant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Solicitor (if any)

Defendant
Name
Surname
DOB
Given name/s
dd/mm/yyyy
State
Postcode
Address
Street
City/Town/Suburb
Other address at which defendant may be found

Address
Street
City/Town/Suburb
State
Postcode
Details of Application
1. Relationship of applicant to defendant
2. Protected persons
Name
Address (if different
Sex
DOB
Relationship to
Applicant
to applicant)
3. Basis of application (tick appropriate box(s))
It is reasonable to suspect that the defendant will commit an act of abuse against the protected person by:
causing personal injury;
causing damage to property;
other (specify)
4. Details of conduct of defendant
4.1 Brief description of background to relationship
4.2 Circumstances and dates of incidents leading to this application such as assaults and injuries, damage to
property, harm to pets, emotional or psychological harm, denial of financial autonomy, threats, intimidation, publishing
harmful matters, stalking and other relevant facts, with details of any supporting witnesses, other evidence and any
reports to police.
5. Orders already in force
If there are any relevant restraining or intervention orders between the protected person(s) and the defendant, give
details of the date they were granted, who they affect and the court of issue and file number and any other
indentifying file references.
6. Other court actions
Give details of any relevant Family Law Act order, Childrens Protection Act order or agreement or order for the
division of property under the Family Law Act 1975 (Cth), or the Domestic Partners Property Act 1996 (SA) or a
corresponding law of another jurisdiction, any pending application for such an order, and any other legal proceedings
between a person proposed to be protected by the order and the defendant, of which the applicant is aware.
7. Other Information
Give details of any weapons in the defendants possession
Provide any other relevant information
8 enter or be within metres of the boundary of the following locations:
9 enter or be within metres of the boundary of any education or care facility attended by the protected person(s) and
at the moment the protected person(s) are attending these facilities at
10 be in possession of the following weapon(s) or article(s):

11 publish on the internet, by email, SMS or other electronic means any material about the protected person(s).
12 cause, allow or encourage another person to do anything forbidden by this order.
13 other:
(clause 14 is permission to remove property and is a matter for the court)
The defendant must:
15 vacate the premises at forthwith upon service of this order and not return to those premises unless this term is
varied or dismissed by the Court.
I, the applicant whose name and particulars appear above, swear/affirm that the contents of this affidavit are true and
correct to the best of my knowledge and belief.
Sworn/affirmed by the applicant at:
In the State of South Australia this day
.............................................................
Applicant
Before me:.............................................................
Justice of the Peace/
Commissioner for taking affidavits
Note to applicant a copy of this affidavit will be given to the defendant
of 20
Form 46
Order for variation or revocation of intervention order

Form 46
ORDER FOR VARIATION OR REVOCATION OF

INTERVENTION ORDER

Section 26
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Defendant
Name
DOB
Surname
Given name/s
dd/mm/yyyy
Applicant
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Protected Person(s)
Names
Surname
DOB
Given name/s
dd/mm/yyyy
Given name/s
dd/mm/yyyy
Given name/s
dd/mm/yyyy
Given name/s
dd/mm/yyyy
DOB
Surname
DOB
Surname
DOB
Surname
The intervention order made on file number dated is hereby:

revoked
varied
Details of variation of intervention order:
a variation or revocation of a related tenancy order has been made separately
a variation or revocation of a problem gambling order has been made separately
Instructions for service:
not to be served
to be served on defendant personally (see proof of service details below)
to be served on defendant by post (for notice of revocation only)
to be served on defendant in some other manner authorised by the court (please specify)
............................................ ..............................................................
Form 47
Application for a control order

Form 47
Court Use
Date Filed:
Date Posted:
Service on Commissioner of Police:
APPLICATION FOR A CONTROL

ORDER
Child Sex Offenders Registration Act 2006

Section 66JA(1)
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
State
Postcode
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
Facsimile
State
Postcode
Email Address
Rank and ID No.
Registrable Offender
Full Name
DOB
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
Facsimile
State
Postcode
Email Address
Grounds of Application:
I make an application for a control order on the basis that
Details of order applied for:
............................................
Date
..............................................................
THE COMMISSIONER OF POLICE
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
IMPORTANT NOTICE TO REGISTRAR
A copy of this application must be served on the Commissioner of Police.
IMPORTANT NOTICE TO THE COMMISSIONER OF POLICE
The Commissioner of Police must serve this application on the registrable offender personally.
IMPORTANT NOTICE TO THE REGISTRABLE OFFENDER
If you do not attend on the hearing date, or any adjourned hearing date, orders may be made in your absence.
AFFIDAVIT OF PROOF OF SERVICE

I,
of
Occupation:
MAKE OATH AND SAY that:
I did on the day of 20 , between the hours of and duly serve the
within named with this application, by delivering a sealed copy thereof to him/her personally at (state the address)
in the State of South Australia
SWORN before me at
.............................................................
on the day of 20
SERVER
Signature .......................................................................
(Person authorised to take Affidavits)
(e.g. Justice of the Peace)
Form 48
Interim control order and summons

Form 48
INTERIM CONTROL ORDER and SUMMONS


Section 66JC(1)
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Rank and ID No.
Full Name
DOB
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Order made:
The Court has heard an application for a control order in your absence.
The Court is satisfied that it was appropriate in all the circumstances to make this order to ensure that the risk that
you pose to the safety and wellbeing of any child or children is reduced.
Details of interim control order:

associate with, or communicate with:
Name Date of birth
Name Date of birth
Name Date of birth
associate with, or communicate with persons of a specified class, namely:
enter or be within metres of the boundary of the following locations:
Address
Address
Address
undertake the following types of employment:
Occupation
Occupation
Occupation
engage in other types of conduct, namely:
Duration of order:
This order will commence upon service of it and:
will remain in force for the period of from the date of the order
or
will remain in place until further order of the Court
Hearing details
Address
Telephone
Registry
Date
Time am/pm
Facsimile
............................................
Date
Email Address
..............................................................
MAGISTRATES COURT

The Commissioner of Police must serve this document on the Registrable Offender personally.
A person who contravenes or fails to comply with an interim control order is guilty of an offence. The maximum
penalty is imprisonment for 5 years.
Form 49
Control order
Form 49
CONTROL ORDER

Section 66JA(1)
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Rank and ID No.
Full Name
DOB
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Order made:
The Court is satisfied that it was appropriate in all the circumstances to make this order to ensure that the risk that
you pose to the safety and wellbeing of any child or children is reduced.
Details of control order:

associate with, or communicate with:
Name Date of birth
Name Date of birth
Name Date of birth
associate with, or communicate with persons of a specified class, namely:
enter or be within metres of the boundary of the following locations:
Address
Address
Address
undertake the following types of employment:
Occupation
Occupation
Occupation
engage in other types of conduct, namely:
Duration of order:
The order will remain in force for the period of from the date of the order.
............................................
Date
..............................................................
MAGISTRATES COURT

If the registrable offender was not in Court when this order was made, the Commissioner of Police must serve
this document on the registrable offender personally.
A person who contravenes or fails to comply with a control order is guilty of an offence. The maximum penalty is
imprisonment for 5 years.

I,
of
Occupation:
within named with this order, by delivering a sealed copy thereof to him/her personally at (state the address)
SWORN before me at
.............................................................
on the day of 20
SERVER
Signature .......................................................................
Form 50
Application for variation or revocation of control order or interim control order

Form 50
Court Use
APPLICATION FOR VARIATION OR

REVOCATION OF CONTROL
ORDER or INTERIM CONTROL
ORDER
Date Filed:
Date Posted:


Section 66JE(1)
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Facsimile
Postcode
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Rank and ID No.
Full Name
DOB
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
This application is in regards to:

Control order made on file number: dated:
Interim control order made on file number: dated:
The applicant seeks to have the order:

varied revoked
Details of variations sought:
Hearing details
Registry
Address
Telephone
Facsimile
............................................
Date
Date
Time am/pm
Email Address
..............................................................
APPLICANT
IMPORTANT NOTICE TO REGISTRAR

A copy of this document must be served on the Commissioner of Police where the Registrable
Offender is the applicant.
The Commissioner of Police must serve this document on the Registrable Offender if it is the
applicant.
If the Commissioner of Police has served you with this document, then the Court can hear and
determine the proceedings whether or not you choose to participate in the hearing.
I,
Occupation:
of

within named with this application, by delivering a sealed copy thereof to him/her personally at (state the address)
SWORN before me at
.............................................................
on the day of 20
SERVER
Signature .......................................................................
Form 51
Order for variation or revocation of control order or interim control order

Form 51
Court Use
Date Filed:
Date Posted:
ORDER FOR VARIATION OR

REVOCATION OF CONTROL ORDER or
INTERIM CONTROL ORDER

Section 66JE(1)
AP Number
Registry
Address
Street
City/Town/Suburb
File No
Telephone
Facsimile
Pos
tco
de
State
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
Facsimile
Pos
tco
de
State
Email Address
Rank and ID No.
Full Name
DOB
dd/mm/yyyy
Address
Street
City/Town/Suburb
Telephone
Facsimile
Pos
tco
de
State
Email Address

Control order made on file number: dated: is hereby:
Interim control order made on file number: dated: is hereby:
varied revoked
Order as varied:
............................................
Date
..............................................................
MAGISTRATES COURT

The Commissioner of Police must serve this document on the Registrable Offender personally.

I,
of
Occupation:
within named with this order, by delivering a sealed copy thereof to him/her personally at (state the address)
SWORN before me at
on the day of 20
Signature .......................................................................
.............................................................
SERVER
Form 53
Application for warrant (Animal Welfare Act)

Form 53
WARRANT
Animal Welfare Act 1985 section 31D

Registry: ...............................................................
Court File No: ......................................................................
............................................................................
...........................................................................
Telephone
Facsimile
personally
Application made:
...........................................................................
E-mail Address
by telephone
by facsimile
Applicant Inspector
Name: ........................................................... ,
Surname
........................................................
ID No: .............................................
Given Name
Address: . .......................................................................
....................................................................
Street
City/Town/Suburb
.....................................................
......................................
..............................................................
State
Postcode
Phone Number
Details of Animal
Type of animal: ................................................
Name of owner: ................................................
Surname
, .......................................................
Given Name
Address: . .......................................................................
Street
.....................................................
State
....................................................................
City/Town/Suburb
......................................
..............................................................
Postcode
Phone
Number
TERMS OF THE WARRANT
I, the undersigned Magistrate, authorise the above inspector to:
* use force in order to exercise the powers conferred on him/her by section 30(1) of the Act.
OR
* exercise the power conferred on him/her by section 31A(4) to destroy the animal in the absence of the owners
consent.
OR
* sell, destroy or otherwise dispose of the above animal
as the relevant Minister sees fit.
I am satisfied that there are reasonable grounds for making this warrant without requiring the personal attendance
of the applicant. (delete if inapplicable)
This warrant expires one month from the date of issue.
DATE OF ISSUE:
/./
REGISTRY OF ISSUE:
.....................................................
Magistrate
Form 53
Warrant (Animal Welfare Act s.31D)

Form 53
WARRANT

Registry: ...............................................................
Court File No: ......................................................................
............................................................................
...........................................................................
Telephone
Facsimile
personally
Application made:
...........................................................................
E-mail Address
by telephone
by facsimile
Applicant Inspector
Name: ........................................................... ,
Surname
........................................................
ID No: .............................................
Given Name
Address: . .......................................................................
....................................................................
Street
City/Town/Suburb
.....................................................
......................................
..............................................................
State
Postcode
Phone Number
Details of Animal
Type of animal: ................................................
Name of owner: ................................................
Surname
, .......................................................
Given Name
Address: . .......................................................................
....................................................................
Street
.....................................................
State
City/Town/Suburb
......................................
..............................................................
Postcode
Phone
Number

I, the undersigned Magistrate, authorise the above inspector to:
OR
consent.
OR
* sell, destroy or otherwise dispose of the above animal as the relevant Minister sees fit.
I am satisfied that there are reasonable grounds for

attendance of the applicant. (delete if inapplicable)
making this warrant without requiring the personal
DATE OF ISSUE:
/./
REGISTRY OF ISSUE:
.....................................................
Magistrate
Form 54
Duplicate warrant (Animal Welfare Act s.31D)

Form 54
DUPLICATE WARRANT
Registry: ...............................................................
Court File No: ......................................................
............................................................................
...........................................................................
Telephone
Facsimile
......................................................
E-mail Address
Name of Magistrate issuing warrant:

Applicant Inspector
Name: ........................................................... ,
Surname
........................................................
ID No: ............................
Given Name
Address: . .......................................................................
...................................................
Street
City/Town/Suburb
.....................................................
......................................
State
Postcode
.............................................
Phone Number
Details of Animal
Type of animal: ................................................
Name of owner: ................................................
Surname
, .......................................................
Given Name
Address: . .......................................................................
...................................................
Street
.....................................................
State
City/Town/Suburb
......................................
.............................................
Postcode
Phone Number

The above inspector has been authorised by the above Magistrate to:
OR
consent.
OR
* sell, destroy or otherwise dispose of the above animal as the relevant Minister sees fit.
DATE OF ISSUE:
/./
REGISTRY OF ISSUE:
.....................................................
Inspector
Form 55
Appeal of enforcement determination

Form 55
Court Use
Fee Paid:
Date Filed:
Service on Issuing Authority:
Service on FERO:
APPEAL OF ENFORCEMENT DETERMINATION

Expiation of Offences Act 1996

Section 14
Registry
Address
File No
Street
Telephone
City/Town/Suburb
State
Facsimil
e
Postcod
e
DX
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcod
e
Email Address
Facsimile
Postcod
e
Email Address
Issuing Authority
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Enforcement Determination Particulars

Expiation Notice No.
Vehicle Registration
Date of Notice of Determination
Offence Particulars
Date of Offence
Date of Enforcement Determination
Grounds
I apply to revoke the enforcement determination on the grounds that I did not commit the offence to which the
expiation notice relates.
I make an application to appeal out of time (this must be sought if the appeal is being made more than 30 days after
the Notice of Determination).
I make an application for an order for suspension of enforcement action for the following reason/s (please also
provide the terms of the enforcement action):
.
You must file and serve an affidavit explaining why you did not commit the offence to which the expiation notice
relates and if you are appealing more than 30 days after the Notice of Determination you must explain the reasons for
the delay.
Please attach the affidavit to this application and any documentary evidence supporting the application. If
available, a copy of the Enforcement Determination and Expiation Notice must be filed.
.................................................. .......................................................................
Date APPLICANT
Registry
Date
Hearing details
Address
Time am/pm
Telephone
Facsimile
Email Address

The Registrar must serve a copy of the appeal on the Fines Enforcement and Recovery Officer and the Issuing
Authority.
I, (issuing Authority)
herby give notice that I intend to oppose the appeal.
.................................................. .......................................................................
Date ON BEHALF OF THE
ISSUING AUTHORITY
IMPORTANT NOTICE TO THE ISSUING AUTHORITY
The above instructions on appeal are to be filed no later than 7 days before the hearing.
Form 56
Application for community service order

Form 56
Court Use
Date Filed:
APPLICATION FOR COMMUNITY

SERVICE ORDER

Section 70U(1)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Debtor
Full Name
Address
Street
City/Town/Suburb
Penalty No.
DOB
Telephone
Facsimile
State
Date Issued
Postcode
Offence
Email Address
Offence Date
Amount Due (Inc.

costs etc)
Total Amount Due: $

Total Amount Includes:
Victims of Crime Levy $
Compensation $
Grounds
I make an application for a Community Service Order on the basis that the Debtor does not have, and is not likely
within a reasonable time to have, the means to satisfy a pecuniary sum without the Debtor or his/her dependants
suffering hardship.
I attach an outline of the financial circumstances of the Debtor to this application.
Availability and Suitability for Community Service
Number of hours available for community service: hours
Suitability for community service has been confirmed.
............................................ ..............................................................
Date FINES ENFORCEMENT AND RECOVERY OFFICER
Registry
Hearing details
Address
Time am/pm
Telephone
Facsimile
Date
Email Address
Proof of Service of Application

Name of deponent:
Service of application effected: personally pre-paid post email
Certified this day
of 20 .................................................................................
Form 57
Application to revoke community service order

Form 57
Court Use
Date Filed:
Date Posted:
APPLICATION TO REVOKE COMMUNITY

SERVICE ORDER

Section 70U(10)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Debtor
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Particulars of the Application

Amount of original pecuniary sum:
Amount of debt paid:
Number of community service hours performed in respect of pecuniary penalty order:
Amount of pecuniary sum outstanding:
The Fines Enforcement and Recovery Officer makes an application for revocation of the community service order and
restoration of a pecuniary sum. This application is made on the basis that the debtor has the means to pay the fine
without himself/herself or his/her dependants suffering hardship.
The Fines Enforcement and Recovery Officer attaches an outline of the financial circumstances of the Debtor to this
application.
.................................................. .......................................................................
Date FINES ENFORCEMENT AND
RECOVERY OFFICER
Hearing details
Registry
Date
Address
Telephone
Facsimile
Time am/pm
Email Address
Proof of Service of Application

Name of deponent:
Service of application effected: personally pre-paid post email
Certified this day
of 20 .................................................................................
Form 58
Application to oppose seizure and sale of assets

Form 58
Court Use
Date Filed:
Date Posted:
Service on FERO:
APPLICATION TO OPPOSE
SEIZURE AND SALE OF
ASSETS
Magistrates Court of South
Australia

Section 70K (11)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Debtor
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Property Subject of the Order Sought

Date on which property was seized:
Please set out the details of the property in question:
(If the property is a vehicle, please include the registration and plate number. For real property, please include Certificate of Title number and
address. If the property is electronics or whitegoods, please provide serial number.)
I claim:
that the above mentioned property is not liable to seizure and sale; OR
an interest in the above mentioned property seized (not being the debtor).
Provide evidence in support of this application in an affidavit (set out full details of the nature of the claim).
Please attach the affidavit to this application. If available, please also attach to this application a copy of the
Written Determination and the Notice listing the property seized.
............................................
Date
..............................................................
APPLICANT
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
A copy of this application, affidavit and if applicable Written Determination and Notice must be served on Fines
Enforcement and Recovery Officer within one working day.
A copy must also be served on the debtor (if the debtor is not the applicant).
IMPORTANT NOTICE TO APPLICANT AND/OR DEBTOR
If you wish to be heard on this application, you should attend court at the date and time stated above otherwise the
court may hear and determine the matter in your absence.
Hearing details
Form 59
Order to exclude property from sale or direct proceeds of sale

Form 59
Court Use
Date Filed:
ORDER TO EXCLUDE PROPERTY

FROM SALE OR DIRECT PROCEEDS
OF SALE

Section 70K(11)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Details of the Order

The application has been refused.
I exclude the following property from sale by the Fines Enforcement and Recovery Officer:
1.
2.
3.
4.
5.
I direct that the proceeds from each item identified below be distributed in the manner specified.
Item
Manner of Distribution
1.
2.
3.
4.
5.
Date of Order:
.................................................. .......................................................................
Form 60
Application to release a seized and clamped or impounded vehicle

Form 60
Court Use
Date Filed:
Date Posted:
Service on FERO:
APPLICATION TO RELEASE A
SEIZED AND CLAMPED OR
IMPOUNDED VEHICLE

Section 70P(6)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Debtor
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Interested Party (If more than one party please attach further particulars)
I advise the court that at the time of making this application, the following person has an interest in this vehicle.
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Nature of interest
Registered Owner
I advise the court that at the time of making this application, the following person is the registered owner of this
vehicle.
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Description of Vehicle
Make
Year of Manufacture
Engine No.
Garaging address
Model
Registration No.
Vehicle Identification No.
I claim an interest in the above mentioned vehicle that has been seized and clamped or impounded.
I make an application for release of the above mentioned vehicle.
Please attach to this application the Written Determination of the Fines Enforcement and Recovery Officer to clamp
or impound and any Notice of Disposal.
Provide evidence of your interest in the vehicle and the grounds for release in an affidavit.
Please attach the affidavit to this application. ..
Date
APPLICANT
Registry
Date
Address
Time am/pm
Telephone
Facsimile
Email Address
A copy of this application and affidavit must be served on the Fines Enforcement and Recovery Officer within one
working day.
A copy must also be served on the debtor, interested party and registered owner (if the person is not the debtor or the
applicant).
IMPORTANT NOTICE TO ALL PARTIES
If you wish to be heard on this application, you should attend court at the date and time stated above otherwise the
court may hear and determine the matter in your absence.
IMPORTANT NOTICE TO THE FINES ENFORCEMENT AND RECOVERY OFFICER
The Fines Enforcement and Recovery Officer is required to notify the Registrar of any interested parties not already on
the application.
Hearing details
Form 61
Order to release a seized and clamped or impounded vehicle

Form 61
Court Use
Date Filed:
ORDER TO RELEASE A SEIZED

AND CLAMPED OR IMPOUNDED
VEHICLE

Section 70P(6)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Description of Vehicle
Make
Year of Manufacture
Registration No.
Garaging address
Model
Engine No.

The application has been refused.
The abovementioned vehicle be released into the custody of:
Name:
Address:
Date of Birth:
The application of the proceeds of the sale of the abovementioned vehicle are to be dealt with in the following
manner:
Date of Order:
............................................
Date
..............................................................
MAGISTRATES COURT
Form 62
Notice of community service order (pecuniary penalties)

Form 62
Court Use
Date Filed:
Date Posted:
NOTICE OF COMMUNITY
SERVICE ORDER (PECUNIARY
PENALTIES)

Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Details of the person against whom the order has been made
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address
Details of the offence(s)/penalties to which the order relates

File No.
Count No.
Offence
Order
The court has considered the application pursuant to s70U(1) and is satisfied that the Debtor does not have, and is not
likely within a reasonable time to have, the means to satisfy a pecuniary sum without the Debtor or his/her dependants
suffering hardship. You are not to leave the State for any reason except with the written permission of the Fines
Enforcement Recovery Officer.
The court has ordered you this day as follows:
1. You are to perform hours of community service within months from the date of this order, and you must, until such
time as you have finished working the required number of hour, obey the lawful directions of the community
corrections officer to whom you are assigned for the purposes of the community service.
2. You are to be under the supervision of a community corrections officer for a period of months from the date of this
order and during that period must obey the lawful directions that are given to you by the community corrections officer
to whom you are assigned for the purposes of supervision.
3. You are to report, within 2 working days of service, at the office of the Department of Community Corrections
closest to your place of residence.
NOTE: You need not report, within the 2 day period, if you receive notice from the Department advising that you do
not have to comply with this requirement.
Date of Order:
What can happen if you fail to comply with this order

If you fail to comply with any part of the order, you can be sentenced to imprisonment for a period not exceeding 12
months, calculated, in the case of a breach of clause 1, on the basis of 1 day for each 7.5 hours of community service
not performed.
Duplicate notice handed to the above named person on the date set out hereunder.
Date ......................................... ..................................................................
RECEIPT ACKNOWLEDGED
Date ......................................... Time ....................... am/pm ..................................................................
SERVER
Form 63
Order for restoration of pecuniary

Form 63
Court Use
Date Filed:
ORDER FOR RESTORATION OF

PECUNIARY SUM

Section 70U(10)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
DX
Email Address
Debtor
Full Name
Address
Street
City/Town/Suburb
DOB
Telephone
State
Facsimile
Postcode
Email Address

I revoke the Community Service Order on the basis that the debtor has the means to pay the fine without the debtor
or his/her dependant suffering hardship.
I order restoration of the pecuniary sum in the amount of:
Date of Order:
............................................
Date
..............................................................
MAGISTRATES COURT
Order for detention mental incapacity provision CLCA
Form 73
Form No 73
SOUTH
AUSTRALIA
MAGISTRATES COURT
ORDER FOR DETENTION

(Detention pursuant to Part 8A, Criminal Law Consolidation Act)
Registry:
File No.:
Address:
Telephone:
Fax:
Complainant /Informant:
Particulars of Defendant
Name:
Date of Birth:
Address:
Details of Offence
Offence Location:
Section and Act:
Terms of Detention Ordered:
Total period of Detention to be Served:
Detention Commencement Date:
Date Order made by Court:
Date Warrant Issued:
To the Sheriff, the Commissioner of Police and Members of the Police Force and the Minister of Health.
The defendant named in this warrant has been dealt with by a Court and, having been declared liable to
supervision, committed for a term of detention pursuant to Division 8A of the Criminal Law
Consolidation Act. Particulars of the Court that imposed the penalty, the charges against the defendant
and the detention imposed appear on this warrant.
You, the Sheriff, and you, the Commissioner of Police and Members of the Police Force, are directed to
convey the defendant to a mental health institution and you, the Minister of Health, are directed to detain
the defendant for such period of time as this warrant directs.
Magistrate
Magistrates Court
Form 74
Warrant of apprehension for forensic procedure

Form 74
WARRANT OF APPREHENSION FOR

FORENSIC PROCEDURE
Criminal Law (Forensic Procedures) Act 2007

Section 29(3) and 29(4)
Registry .............................................................
File No ............................................
Address ...............................................................
...............................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Suspect or Offender
Name:..................................................... , ................................................ DOB..................................
Address ............................................................................................... ..................................

..................................... ............ .............................

Police reference number:
Details of Warrant
I, a Stipendiary Magistrate in the State of South Australia, AM SATISFIED that the respondent has
failed to comply with directions issued under section 29(1) of the Criminal Law (Forensic Procedures)
Act 2007.
To the Commissioner of Police for the State of South Australia and each member of the Police Force
for the State.
You are authorised to apprehend the respondent and bring the respondent to a Police Station for the
purpose of carrying out the forensic procedure specified in the order attached to this warrant.
...................................................
MAGISTRATES COURT
Magistrate
Form 75
Fortification removal order

Form 75
FORTIFICATION REMOVAL ORDER

Summary Offences Act 1953,

Section 74BB
Registry
.............................................................
File No
............................................
Address
..............................................................................................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Applicant
Commissioner of Police
Adelaide
E-mail ...............................................
Occupier
Contact person
..............................................
Telephone
..............................................
(if more than one, attach details)
Name:..................................................... , ................................................ DOB..................................

surname
dd/mm/yy
Address
given name
.....................................................................................................
..............................
street
licence
number
..................................................................................................
city/town/suburb
state
postcode
Owner (if more than one, attach details)

Name:..................................................... , ................................................ DOB..................................
surname
dd/mm/yy
Address
given name
.....................................................................................................
..............................
street
licence
number
..................................................................................................
city/town/suburb
state
postcode
Premises to which Order relates

Address
..................................................................................
CT ref #.................................
street
..................................................................................................
city/town/suburb
state
postcode
The Court was satisfied that:The premises to which this order relates are fortified; and
The fortifications have been created in contravention of the Development Act 1993
There are reasonable grounds to believe the premises are being, or have been, or are likely to be, used
for or in connection with the commission of a serious criminal offence
to conceal evidence of a serious criminal offence
to keep the proceeds of a serious criminal offence
The premises are
owned by a declared organisation or a member of a declared organisation

occupied or habitually used as a place of resort by members of a declared organisation
Statement of grounds: .............................
.......
...................
........
A copy of the affidavit that was used as evidence of the grounds is attached
You, the aforementioned owner/occupier are ordered to remove/modify the following
structures/devices/fortifications (specify details)
.......
Period within which fortifications are to be removed or modified:.

(not less than 14 days after service of the order)
Right to object (section 74BE)
You may lodge a notice of objection with the Court within 14 days of being served with this order. A form of Notice of
Objection may be obtained from any Registry of the Magistrates Court. You must serve a copy of the notice on the
Commissioner of Police personally or by registered post at least 7 days before the day appointed for hearing of the
notice.
You cannot lodge a notice of objection if a notice has previously been lodged in relation to the fortification removal order
(unless proceedings in relation to the earlier notice have been discontinued).
The grounds of the objection must be stated fully and in detail in the notice of objection.
Enforcement of this Order (section 74BI)

The Commissioner of Police may cause the fortifications to be removed or modified to the extent required by this order if you
do not comply with the order, unless a withdrawal notice is lodged, a notice of objection is lodged, an appeal is commenced
or the Commissioner allows an extension of time.
Should you require an extension of time, you must make an application to the Commissioner of Police before the time
allowed elapses.
If the fortifications are not removed or modified in the time allowed, the Commissioner, or any police officer authorised by the
Commissioner, may, for the purposes of causing the fortifications to be removed or modified, enter the premises without a
warrant, obtain expert or technical advice, and/or make use of any person or equipment he or she considers necessary.
The Commissioner may seize anything that may be salvaged in the course of removing or modifying fortifications under this
section, and may sell or dispose of it as the Commissioner considers appropriate. If the costs of enforcing the order are not
recovered, the Commissioner may recover those costs as a debt from you or another person.
Proof of Service
I .................................................................................................................................................................. of
.................................................................................................................................................................
Certify that I served this fortification removal order on all occupier(s) and owner(s) on the ................ day of
.............................. 20......... in the following manner (tick appropriate box):-
By delivering it personally
By registered post
By affixing a copy of the order to the premises at a prominent place at or near to the entrance to the
premises.
Certified this ........ day of ........................... 20.....
.............................................................
Form 77
Withdrawal notice 9Fortification Removal Order, SOA s.74BH)

Form 77
WITHDRAWAL NOTICE

Section 74BH
Registry
..........................................................
File No
............................................
Address
.................................................................................................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Applicant
Adelaide
E-mail
...............................................
Occupier
Contact person
..............................................
Telephone
..............................................
Name:..................................................., ..............................................
surname
dd/mm/yy
Address
DOB...............................
given name
.....................................................................................................
..............................
street
licence number
..................................................................................................
city/town/suburb
state
postcode

Name:.....................................................,................................................DOB..................................
surname
given name
Addressdd/mm/yy .....................................................................................................
..............................

Address
............................................................................... CT ref #................................

street
..................................................................................................
city/town/suburb
state
postcode
The Commissioner has determined that the Fortification Removal Order made on the ............ day of
.................................., 20....... will not be enforced and hereby withdraws the Order
Proof of Service
I ................................................................................................................................................................ of
..............................................................................................................................................................
Certify that I served this withdrawal notice on all persons on whom a copy of the Order was served on the
................ day of .............................. 20......... in the following manner (tick appropriate box):-
By delivering it personally;
By registered post;
premises.
.............................................................
Form 77
Withdrawal notice (fortification removal order, SOA s.74BH)

Form 77
WITHDRAWAL NOTICE

Section 74BH
Registry
..........................................................
File No
............................................
Address
.................................................................................................................................
............................................
............................................
............................................
telephone
facsimile
e-mail address
Applicant
Adelaide
E-mail
...............................................
Occupier
Contact person
.............................................
Telephone
..............................................
Name:..................................................., ..............................................
surname
dd/mm/yy
Address
DOB...............................
given name
.....................................................................................................
..............................
street
licence number
..................................................................................................
city/town/suburb
state
postcode

Name:.....................................................,................................................DOB..................................
surname
given name
Addressdd/mm/yy .....................................................................................................
..............................
street
licence number
..................................................................................................
city/town/suburb
state
postcode

Address
............................................................................... CT ref #................................

street
..................................................................................................
city/town/suburb
state
postcode
The Commissioner has determined that the Fortification Removal Order made on the ............ day of
.................................., 20....... will not be enforced and hereby withdraws the Order
Proof of Service
I ................................................................................................................................................................ of
...........................................................................................................................................................
Certify that I served this withdrawal notice on all persons on whom a copy of the Order was served on the
................ day of .............................. 20......... in the following manner (tick appropriate box):-
By delivering it personally;
By registered post;
premises.
.............................................................
Form 78
Warrant of arrest (Criminal Law (Sentencing) Act, 1988, s.71(3)(a),71 (4))

Form 78
WARRANT OF ARREST
Criminal Law (Sentencing) Act, 1988 Sections 71(3)(a) and 71 (4)
Registry ............................................................... File No ....................................................................

Address .....................................................................................................................................................
.....................................................................................................................................................
...................................................... .................................................
...................................................
telephone facsimile email address
DEFENDANT
Name ........................................................ , ................................................ DOB ............................
surname given name dd/mm/yy
Address .....................................................................................................................................................
street
.....................................................................................................................................................
Licence No. .................................................................

ENDORSEMENT Pursuant to section 5(2)(b) of the Bail Act 1985
Variable 1 The defendant may not be released on bail
Variable 2 At the discretion of a member of the Police Force who is of, or above, the rank of Sergeant or
who is in charge of a police station, the defendant may be released on bail.
Variable 3 Person or class of persons authorised/required to release the defendant on bail following
arrest ..........................................................
Registrar/Justice of the Peace .....................................................
To the Commissioner of Police for the State of South Australian and each member of the Police Force for the State
You are directed to arrest the defendant and, subject to any endorsement below, bring the defendant as soon as
practicable before the Court to be further dealt with according to law.
....................................................................
MAGISTRATES COURT
PARTICULARS
It appears to the court, by evidence given on oath, that the defendant has failed to appear in court as
required by a notice issued pursuant to Section 71(3)(a) of the Criminal Law (Sentencing) Act 1988
Date warrant issued ...................................................
....................................................................
MAGISTRATES COURT

arrest .......................................................... Registrar/Justice of the Peace
.....................................................
Form 79
Application for review of licence disqualification/suspension (Road Traffic Act 1961 s47IAB)
Form 79
APPLICATION FOR REVIEW OF LICENCE

DISQUALIFICATION/SUSPENSION
Road Traffic Act 1961 - Section 47IAB

Registry at which Application is made
File No ............................................
.............................................................
Party details
Applicant
Name:..................................................... , ............................................. DOB..................................
Address ..................................................................................................... ..................................

.................................................................................................. . ..
city/town/suburb state postcode telephone mobile
Respondent
Name South Australian Police, .......................................... ..
Disqualification Notice Number Brief number
Address ..
On the .. day of 20, a member of the South Australian Police issued and handed a
Notice of Disqualification/Suspension pursuant to Section 47IAA of the Road Traffic Act 1961, commencing
on /../ to me. (copy of notice attached)
I apply to the Magistrates Court for the following order:
That I am not Disqualified/Suspended as there is a reasonable prospect that I would be acquitted of the offence. (S
47IAB(2)(a) RTA)
That the Disqualification/Suspension be reduced as the offence is a first offence and was trifling. (S 47IAB(2)(b)(i) RTA)
That the Disqualification/Suspension be reduced as there is a reasonable prospect that I would be acquitted of a
Category 3 offence but may be guilty of a Category 2 offence. (S 47IAB(2)(b)(ii) RTA)
The grounds for the application and the evidence that will be relied upon are: (copies of documents attached)
Blood Test Blood taken at . am/pm on the . day of 200. Blood Test Result: %
Opinion of Doctor ..(Doctors Name) dated day of . 20.
Other :- give details
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I have not received a summons charging me with any offence which relates to the notice of
disqualification/suspension served on me
I have/have not also received a notice from the Registrar of Motor Vehicles containing particulars of my licence
disqualification/suspension.
..........................................................................................
I understand that if I drive whilst disqualified/suspended I may be imprisoned. (S 91(5) MVA)
Hearing date
Registry....................................... Date....................................
..............
Address.....................................................
Time ................................. am/pm
....................................... ................................................. ................................... .....
telephone facsimile e-mail address
..............................
date
...........................
MAGISTRATES COURT
Form 80
Application for special arrangements (Evidence Act)

Form 80
APPLICATION FOR SPECIAL ARRANGEMENTS

Evidence Act 1929 Section 13A

Registry .............................................................
File No ............................................
....................................... ................................................. ................................... .....
telephone facsimile e-mail address
Applicant
Name:.....................................................,............................................. ..
surname given name D.O.B/ID No.
Address .......................................................................................................................................
................................................................................................
Respondent(s)
Name:.....................................................,............................................. ..
surname given name D.O.B/ID No.
Address .......................................................................................................................................
................................................................................................
Details of witness including nature of vulnerability:

Special arrangements sought:
..........................................................................................
State whether Applicant is Complainant/Informant or Defendant.............................................................
Hearing date
Registry...................................... Date....................................
...............
Address.....................................................
Time ................................. am/pm
I certify that I have served a copy of this notice on the respondent(s) within 14 days of it being filed in court.
..............................
date
...........................
MAGISTRATES COURT
To the Respondent(s): If you are of the opinion that there should not be special
arrangements made for the above witness, you must file a Notice of Objection (Form 81) in
the Court within 14 days of being served with this application.
Form 81
Notice of objection (Evidence Act)

Form 81
NOTICE OF OBJECTION
Evidence Act 1929 Section 13A
Registry .............................................................
.......................................
telephone
File No
............................................
.................................................
facsimile
e-mail address
Respondent
Name:.....................................................,.............................................
surname
D.O.B/ID No.
Address
........................................
..
given name
.......................................................................................................................................
street
telephone
facsimile
................................................................................................
city/town/suburb
state
postcode
Applicant
Name:.....................................................,.............................................
surname
D.O.B/ID No.
Address
e-mail address
..
given name
.......................................................................................................................................
street
telephone
facsimile
................................................................................................
city/town/suburb
state
postcode
e-mail address
Grounds of Objection:
..........................................................................................
Respondents signature
Hearing date
Registry.....................................................
Date....................................
Address.....................................................
Time .................................am/pm
I certify that I have served a copy of this notice on the applicant within 14 days of it being filed in court.
..............................
date
...........................
MAGISTRATES COURT
The respondent must file this Notice in the Court within 14 days of being served with the Application for
Special Arrangements.
Form 82
Warrant of arrest fail community service (Criminal law (Sentencing) Act 1988, s71(3)(b))
Form 82
WARRANT OF ARREST

Criminal Law (Sentencing) Act, 1988 Section 71(3)(b)
Registry ............................................................... File No ....................................................................

Address .....................................................................................................................................................
.....................................................................................................................................................
...................................................... .................................................
...................................................
telephone facsimile email address
DEFENDANT
Name ........................................................ , ................................................ DOB ............................
surname given name dd/mm/yy
Address .....................................................................................................................................................
street
.....................................................................................................................................................
Licence No. .................................................................

arrest ..........................................................
....................................................................
MAGISTRATES COURT
PARTICULARS
It appears to the court, by evidence given on oath, that the defendant has failed to comply with an order
requiring performance of community service.
Date warrant issued ...................................................
arrest ..........................................................
....................................................................
MAGISTRATES COURT
ENDORSEMENT
Pursuant to section
5(2)(b) of the Bail Act 1985

arrest ..........................................................
Form 83
Application for clamping, impounding and forfeiture of vehicles

Form 83
Court Use
APPLICATION
Criminal Law (Clamping, Impounding and Forfeiture of

Vehicles) Act 2007 Sections 7(1), 12(1) and 21(1)
Registry: ...............................................................
date filed
Court File No: ............................................................
Applicant:
Name: ........................................................... ,
........................................................
Surname
ID No: ....................................
Given Name
Address:.......................................................................................................................................................
Street
......................................................
City/Town/Suburb
.......................................
State
......................................................
Postcode
Phone Number
Person against whom the order is to be made:

Name: ............................................................. ,
...............................................
Surname
Given Name
Address: ......................................................... ,
........................................................ DOB:
Street
.....................................................,
Reference:
Telephone
...................
City/Town/Suburb
State
.......................
dd/mm/yy
........................................................
Postcode
E-mail Address
Order sought:
Extension of clamping period (section 7(1))
Forfeiture of motor vehicle (section 12(1)(a)(i))
Forfeiture of motor vehicle (section 12(1)(a)(ii))
Forfeiture of motor vehicle (section 12(1)(a)(iii))
Impounding of motor vehicle (section 12(1)(b)(i))
Removal of clamps or release of an impounded motor vehicle (section 21(1)(a))
Payment out of proceeds of sale (section 21(1)(c))
Details: ............................................................................................................................................................................
Details of the Motor Vehicle

Make: ............................................................................
Model: ...............................................................
Year of Manufacture:.....................................................
Registration Number: ........................................
Engine Number: ............................................................
Vehicle Identification Number: ...........................
Garaging Address: .......................................................................................................................................

Clamping Offence Details
Details of Offence: ........................................................
Date of Offence: ................................................
Date of Conviction: ......................... Court File Number:

Details of Clamping or Impounding
Court Order was made: .................................................
Court File Number: ............................................
Date of Order: ...............................................................

Details of Order made under Part 2 or Part 3: .............................................................................................
Previous Prescribed Offences Alleged
Details of Offence: ........................................................
Date of Offence: ................................................
Date of Conviction: ........................................................

Court File Numbers: .....................................................................................................................................
[Insert extra pages if necessary]
I advise the Court that at the time of making this application, the following person/s had an interest in this
vehicle:
Name: ...........................................
Address: ...........................................................................................
Phone: ..........................................
Nature of interest: .............................................................................
............................................................
............................................................
.............................................
Date
Applicant
[Insert extra pages if necessary]
Hearing Date
Registry:.....................................
Date: ......................................................................
Address .....................................
Time: ............................................................ am/pm
...........................................................................
Telephone
............................................
Date
....................................................................
.......................................................................
Facsimile
E-mail Address
..........................................................................................
Registrar
If you do not attend on the hearing date, or any adjourned hearing date, orders may be made in
your absence. You may request to make representations to the Court relating to the application at
this hearing date.
Notice to the Registrar:
All registered owners, holders of any secured

interests or people who claim ownership of the
motor vehicle or are likely to suffer financial or physical hardship as a result of the making of the order
must be served with this application and notice of the hearing date. If the application is made pursuant to
s 21, the application and notice must also be served on the Commissioner of Police (if the order was
made under Part 2) or the Sheriff (if the order was made under Part 3).
I certify that I have served a copy of this notice on the parties listed above.
Date: ..........
Signature: ...... ...

(Registrar Trial Court)
Form 84
Order to extend clamping period or offer for impounding or forfeiture of motor vehicle
Form 84
ORDER TO EXTEND CLAMPING PERIOD or

ORDER FOR IMPOUNDING or FORFEITURE OF MOTOR
VEHICLE
Criminal Law (Clamping, Impounding and Forfeiture of Vehicle)Act 2007

Section 7(1) and 12(1)
Registry
Address
Street
City/Town/Suburb
File No
Telephone
State
Facsimile
Postcode
Email Address
Applicant
Name
ID No.
Surname
Given name/s
Address
Street
City/Town/Suburb
State
Postcode
Telephone
Person against whom the order is to be made

Name
Reference
Surname
Given name/s
Address
DOB
Street
City/Town/Suburb
Telephone
dd/mm/yyyy
State
Facsimile
Postcode
Email Address
Date of the motor vehicle

Make
Year of Manufacture
Engine No.
Garaging address
Model
Registration No.
Details of Order:
Extension of clamping period (section 7(1))
I, the undersigned, am satisfied that the above-mentioned vehicle was used in the commission of a prescribed
offence and the said vehicle shall remain clamped for a further period of days from
or
Impounding of motor vehicle for (not exceeding) 6 months (section 12(1)(b)(i))
I, the undersigned, am satisfied that has on the been convicted of a prescribed offence, namely
I, the undersigned, am also satisfied that the defendant has, within 10 years of the date of the above prescribed
offence, been found guilty of or expiated 1 other prescribed offence, namely
committed on the
I order that the motor vehicle be impounded by the Sheriff for a period of days/months commencing from the date of
seizure.
Pursuant to Section 12(5) of the Criminal Law (Clamping, Impounding and Forfeiture of Vehicles) Act 2007, the
relevant authority is authorised to seize the above-mentioned vehicle and deal with it in accordance with Parts 4 and
5 of the Act.
or
Forfeiture of motor vehicle (sections 12(1)(a)(i),(ii), (iii))
I, the undersigned, am satisfied that has on the
been convicted of a forfeiture offence, namely
I order that the motor vehicle be forfeited to the Crown.
been convicted of a prescribed offence, namely
I am also satisfied that within 12 months of the above prescribed offence, the defendant has been found guilty of, or
expiated one other prescribed offence, namely committed on
I order that the motor vehicle be forfeited to the Crown.

been convicted of a prescribed offence, namely
I am also satisfied that within 10 years of the date of the above prescribed offence, the defendant has been found
guilty of or expiated two or more previous prescribed offences, namely
committed on
I order that the motor vehicle be forfeited to the Crown. Pursuant to Section 12(5) of the Criminal Law (Clamping,
Impounding and Forfeiture of Vehicles) Act 2007 the relevant authority is authorised to seize the above-mentioned
vehicle and deal with it in accordance with Parts 4 and 5 of the said Act.
and
Pursuant to Section 12(4) of the said Act, I made the following ancillary orders that the convicted person will:
Pursuant to Section 12(1a) of the Act, I order that the convicted person pay to the relevant authority, fees calculated
in accordance with the Criminal Law (Clamping, Impounding and Forfeiture of Vehicles) Regulations 2007, in relation
to the impounding and or forfeiture of the motor vehicle, namely the sum of $ .
............................................ ..............................................................
Date
MAGISTRATE
I certify that I have served a copy of this notice on all parties who have an interest in the motor vehicle.
............................................ ..............................................................
Date
REGISTRAR
Form 85 Order for relief (Criminal law (Clamping, Impounding and Forfeiture of Vehicles) Act 2007
s.12(1))
Form 85

Order for Relief
Vehicles) Act 2007 Section 12(1)
Registry: ..
Court File No:..
Applicant:
Name: ........................................................... ,
........................................................
..
Given Name
DOB
Surname
Address:
Street
......................................................
State
City/Town/Suburb
.......................................
..............................................................
Postcode
Phone Number

Make:
....................................................................................
Year of Manufacture:
Model: ...............................................................................
............................................................
Registration Number: .......................................................
Engine Number:
Vehicle Identification Number: ............................................
Garaging Address:
DETAILS OF THIS ORDER

I, the undersigned, am satisfied that the rights of the credit provider would be significantly prejudiced if this order
were not made, and make an order that:
[ * Delete condition not applicable]
* any clamps affixed to the abovementioned motor vehicle under this Act be removed
* the abovementioned motor vehicle impounded under this Act be released to the credit provider
OR
I, the undersigned, am satisfied that the credit provider has suffered, or will suffer, loss as a result of the exercise of
powers under this act and make an order that:
The amount of .. be paid to the credit provider out of the proceeds of sale of the
abovementioned motor vehicle (provided that such amount will only be payable if sufficient proceeds remain after
the deduction of costs and fees in accordance with s.20(6).
Any other orders:
DATE OF ORDER:
//
REGISTRY OF ISSUE:
Magistrate
Form 86 Application for a warrant to seize a motor vehicle (Criminal Law (Clamping, Impounding and
Forfeiture of Vehicles) Act 2007 s.17(2))
Form 86

Application for a warrant to seize a Motor Vehicle
Vehicles) Act 2007 - Section 17(2)
Registry: ...............................................................
Court File No: ......................................................................
Applicant:
Relevant Authority:
Name: ........................................................... ,
........................................................
Surname
Given Name
Address: ., ....................................................................................
Street
......................................................
ID No: .............................................
City/Town/Suburb
......................................
State
.......................................................
Postcode
.............................................................
Phone Number
Person against who the order is to be made:

Name: ............................................................. ,
...............................................
Surname
Address: ......................................................... ,
Given Name
........................................................ DOB: .............................................
Street
..................................................... ,
City/Town/Suburb
Reference: ...........................................
Telephone
...................
State
.......................
Postcode
dd/mm/yy
.................................................................
E-mail Address

Make: ....................................................................................
Model: ................................................................................
Registration Number: ........................................................
............................................................
Engine Number: .......................................................................................................................................................................

Vehicle Identification Number: .................................................................................................................................................
Garaging Address: ..................................................................................................................................................................
Terms sought:
This warrant authorises any member of the relevant authority, with assistants the member considers necessary to:
Enter the place at which the abovementioned motor vehicle is suspected to be located
Search the place for the motor vehicle
Use reasonable force to break into or open any garage or other structure in with the motor vehicle may be stored
Seize the motor vehicle, and otherwise deal with it, in accordance with the Act.
Grounds on which the application is made:
The grounds of the application must be verified by affidavit
Hearing Date
Registry: ...............................................................................
Date: ........................................................
Address ...............................................................................
Time: ...........................................am/pm
...........................................................................
Telephone
...................................................................
Facsimile
..........................................
..........................................................................................
Date
Registrar
.................................................................................
E-mail Address
Form 87 Warrant of seizure of motor vehicle (Criminal Law Clamping, Impounding and Forfeiture of
Vehicles) Act 2007 s.17(2)
Form 87

Warrant of Seizure of Motor Vehicle
Registry:
..
No:..
Court File

Name: ............................................................. ,
...............................................
Surname
Address: ......................................................... ,
Given Name
........................................................ DOB: .............................................
Street
.....................................................,
Reference: ..........................................
Telephone
...................
City/Town/Suburb
State
.......................
dd/mm/yy
................................................................
Postcode
E-mail Address
Details of the Motor Vehicle:

Make:
....................................................................................
Model: ...............................................................................
............................................................
Engine Number:
Garaging Address:
.
TO:
THE SHERIFF OF SOUTH AUSTRALIA/ COMMISSIONER OF POLICE OF SOUTH AUSTRALIA
I, the undersigned, authorise you to enter ...

and to search that place for the above mentioned motor vehicle and to
use reasonable force to break into or open any garage or other structure in which the above mentioned vehicle
may be stored and to seize the above mentioned motor vehicle and otherwise deal with it in accordance with Part 4
of the Criminal Law (Clamping, Impounding and Forfeiture of Vehicles) Act 2007.
I order that the abovementioned motor vehicle be [ * Delete whichever is inapplicable]
* impounded for a period of months/days commencing on ...

* forfeited to the Crown
I order that the defendant pay to the Relevant Authority the prescribed costs and fees for the seizure and
impoundment of the motor vehicle.
This warrant expires one month from the date of issue
DATE OF ISSUE:
/./
REGISTRY OF ISSUE:
.....................................................
Magistrate
Form 88
Warrant of seizure of motor vehicle [telephone application] (Criminal Law (Clamping,

Impounding and Forfeiture of Vehicles) Act 2007 s.17(2))
Form 88

Warrant of Seizure of Motor Vehicle
[Telephone Application]
NAME OF MAGISTRATE ISSUING
WARRANT:
POLICE/SHERIFFS OFFICER APPLYING FOR WARRANT

Name:
Rank & Number:

Name: ............................................................. ,
...............................................
Surname
Address: ......................................................... ,
Given Name
........................................................ DOB: .............................................
Street
.....................................................,
City/Town/Suburb
Reference: ..........................................
Telephone
...................
State
.......................
Postcode
dd/mm/yy
................................................................
E-mail Address

Make:
....................................................................................
Model: ...............................................................................
............................................................
Engine Number:
Garaging Address:
.
In my opinion a warrant is urgently required and there is not enough time to make an application
Personally FACTS THAT JUSTIFY THE ISSUE OF THE WARRANT
[attach additional pages if insufficient space]

This warrant authorises any member of the relevant authority, with assistants the member considers
necessary to:
Use reasonable force to break into or open any garage or other structure in with the motor vehicle may
be stored
DATE OF ISSUE:
/./
TIME OF ISSUE:
..
.....................................................
Magistrate
Form 89
Duplicate warrant of seizure of motor vehicle (Criminal Law (Clamping, Impounding and
Forfeiture of Vehicles) Act 2007 s17(2))
Form 89

Duplicate Warrant of Seizure of Motor Vehicle
NAME OF MAGISTRATE ISSUING

WARRANT:
POLICE/SHERIFFS OFFICER APPLYING FOR WARRANT

Name:
Rank & Number:

Name: ............................................................. ,
...............................................
Surname
Address: ......................................................... ,
Given Name
........................................................ DOB: .............................................
Street
.....................................................,
City/Town/Suburb
Reference: ..........................................
Telephone
...................
State
.......................
Postcode
dd/mm/yy
................................................................
E-mail Address

Make:
....................................................................................
Model: ...............................................................................
............................................................
Engine Number:
Garaging Address:
.
The magistrate has informed me that, in the opinion of the magistrate, the following facts justify the issue of
the warrant:
[attach additional pages if insufficient space]

I undertake to make an affidavit verifying those facts

This warrant authorises any member of the relevant authority, with assistants the member considers
necessary to:
Use reasonable force to break into or open any garage or other structure in with the motor vehicle may
be stored
DATE OF ISSUE:
/./
TIME OF ISSUE:
..
.....................................................
Police officer/Sheriffs officer
Form 90 Application for warrant to enter and search premises (Road Traffic Act 1961 s.40T and 341B)
Form 90
APPLICATION FOR WARRANT TO ENTER AND

SEARCH PREMISES
Court Use

Date Filed:
Road Traffic Act 1961

Section 40T and 41B
Registry
File No
Address
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
Purpose for which the warrant is required:
State
Postcode
DX
Grounds on which the warrant is sought:

Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
..................................................
.......................................................................
Date
MAGISTRATES COURT
Form 91
Warrant to enter and search premises (Road Traffic Act 1961 s.40T and 41B)
Form 91
WARRANT TO ENTER AND SEARCH PREMISES
Court Use

Road Traffic Act 1961
Date Filed:
Section 40T and 41B

Registry
File No
Street
Address
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Authorised Officer
ID No.
Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
State
Postcode
Application made:
Personally
By telephone/facsimile in my opinion, the following facts justify the issue of the warrant:
The authorised officer undertakes to forward an affidavit verifying the facts relied on above.
Terms of the warrant

I, the undersigned Magistrate, am satisfied that there are reasonable grounds for believing that:
there may be at the particular premises named above, then or within the next 72 hours, records, devices or
other things that may provide evidence of an Australian road law offence; or
a vehicle has been involved in an accident and (i)
the vehicle is or has been located at the particular premises named above; or
(ii)
the particular premises are or may be otherwise connected (directly or indirectly) with the vehicle or any
part of its equipment or load.
I authorise that the above authorised officer may, with necessary and reasonable help and force, enter and search
the above particular premises, and seize and remove any records, devices or other things that the authorised officer
believes on reasonable grounds provide, or may on further inspection provide, evidence of an Australian road law
offence.
The followings conditions and limitations apply to this warrant, namely:
The above authorised officer may apply for this warrant to be varied or renewed.
This warrant will be enforced for a period of
days (not longer than 45 days) and can be executed at any time.
..................................................
..................................................
.......................................................................
Date
MAGISTRATE
Form 92 Duplicate warrant to enter and search premises (Road Traffic (Miscellaneous) Regulations 1999,
Reg 10)
Form 92
DUPLICATE WARRANT TO ENTER AND SEARCH

PREMISES
Court Use

Date Filed:
Road Traffic (Miscellaneous) Regulations 1999

Regulation 10
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
State
Postcode
This application was made by telephone or facsimile and the above magistrate was satisfied that the following facts
justify the issue of the warrant:
I undertake to forward an affidavit verifying the facts the magistrate has relied on as grounds for the issue of the
warrant.

The above Magistrate is satisfied following a telephone or facsimile application that there are reasonable grounds
for believing that:
there may be at the particular premises named above, then or within the next 72 hours, records, devices or
other things that may provide evidence of an Australian road law offence; or
a vehicle has been involved in an accident and (i)
the vehicle is or has been located at the particular premises named above; or
(ii)
the particular premises are or may be otherwise connected (directly or indirectly) with the vehicle or any
part of its equipment or load.

The above Magistrate has authorised that the above authorised officer may, with necessary and reasonable help
and force, enter and search the above particular premises, and seize and remove any records, devices or other
things that the authorised officer believes on reasonable grounds provide, or may on further inspection provide,
evidence of an Australian road law offence.
The followings conditions and limitations apply to this warrant, namely:
The above authorised officer may apply for this warrant to be varied or renewed.
This warrant will be enforced for a period of
days (not longer than 45 days) and can be executed at any time.
..................................................
..................................................
.......................................................................
Date
AUTHORISED OFFICER
Form 93
Application for search warrant (National Electricity Law s.21 or National Gas Law s.35)
Form 93
APPLICATION FOR SEARCH WARRANT

National Electricity Law section 21 or National Gas Law section 35
Registry:
..
No:..
Court File
Authorised person under section 20 (Electricity) or 32 (Gas):

Name: ............................................................. ,
Surname
...............................................
ID No:
...................
Given Name
Address: ......................................................... ,
Street
........................................................
City/Town/Suburb
.....................................................,
State
...........................................
...............................
Postcode
....................................
E-mail address
Phone Number
Specified premises:
Address: ......................................................... ,
Street
........................................................
City/Town/Suburb
...............................
Postcode
.....................................................,
State
Grounds for warrant:
I believe on reasonable grounds that there is or has been or will be a breach of the following
provision of the National Electricity Law/National Gas Law: ................................, and that there
is or may be a thing or things of a particular kind connected with that breach on or in that place;
or
I reasonably suspect that there may have been a breach of the following provision of the
National Electricity Law/ National Gas Law: .............................., and that there is or may be a
thing or things of a particular kind connected with that breach on or in that place.
Thing/s sought:
Reasons for belief:
The grounds for the warrant must be supported by evidence on oath or by affidavit
Hearing Date
Registry: ..................................................................
Date: .....................................................
Address: ..........................................................
Time:
..........................................
..........................................................................................
Date
Registrar
........................................
am/pm
Form 94
Search warrant (National Electricity Law s.21 or National Gas Law s.35)
Form 94
SEARCH WARRANT
Registry:
..
Court File No:..
Authorised person under section 20 (Electricity) or 32 (Gas):

Name: ............................................................. ,
Surname
...............................................
ID No: ...........................
Given Name
Address: ......................................................... ,
........................................................
City/Town/Suburb
.....................................................,
State
...........................................
...............................
Postcode
....................................
E-mail address
Phone Number
Specified premises:
Address: ......................................................... ,
........................................................
City/Town/Suburb
...............................
Postcode
.....................................................,
State
SEARCH WARRANT
I, the undersigned Magistrate, authorise the person named above to enter the above premises with such
assistance and by the use of such force as is necessary and reasonable in order to search the place or any part of
it and to search for and seize the following thing(s) connected with a breach or possible breach of a provision of the
National Electricity Law or the National Gas Law: ....................................................................................................
..................................................................................................................................................................................
..................................................................................................................................................................................
The authorised person may inspect, examine or record an image of anything in the place; take extracts from,
and make copies of, any documents in the place; and take into the place such equipment and materials as the
person requires for exercising the powers.
This search is required for the following purpose....................................................................................................
.................................................................................................................................................................................
.................................................................................................................................................................................
The nature of the suspected breach of the relevant provision is:............................................................................
.................................................................................................................................................................................
.................................................................................................................................................................................
This warrant is subject to the following conditions: .................................................................................................

.................................................................................................................................................................................
.................................................................................................................................................................................
Entry into the premises is authorised to be made at any time of the day or night / between the following
hours:................................................................................... (delete that which does not apply)
This warrant will cease to have effect on:............................. (not later than 7 days after the issue of the warrant)
DATE OF ISSUE:
/./
REGISTRY OF ISSUE:
.....................................................
Magistrate
Form 95
Application for extension

Form 95
APPLICATION FOR EXTENSION OF PERIOD OF RETENTION

Registry: ...............................................................
Court File No: .....................................................................
............................................................................
............................................................................
Telephone
Facsimile
........................................................................
E-mail Address
Applicant: The Australian Energy Regulator

Name: ........................................................... ,
Surname
Address: . .........................
Street
.....................................................
State
........................................................
ID No: ................................
Given Name
..........................
City/Town/Suburb
......................................
....................................
Postcode
.................................................
DX Number
Phone Number
Description of document/s or thing/s:
Owner:
Name: ........................................................... ,
Surname
........................................................
Given Name
Address: . ....................................................................................
Street
.....................................................
State
DOB: ..................................
...........................................
City/Town/Suburb
......................................
Postcode
Purpose for which document or thing was retained:
.................................................
Phone Number
Grounds for the extension:
Period of extension sought:
Hearing Date
Registry: ...............................................................................
Date: ........................................................
Time: .....................................am/pm
Address ................................................................................
..........................................
..........................................................................................
Date
Registrar
Form 96
Application for search warrant (Rail Safety National Law (SA) Act 2012, par 150 of the
Schedule)
Form 96
APPLICATION FOR SEARCH WARRANT
Court Use

Rail Safety National Law (South Australia) Act 2012
Date Filed:
Paragraph 150 of the Schedule

Registry
Address
File No
Street
Telephone
City/Town/Suburb
State
Postcode
Facsimile
Email Address
Rail Safety Officer

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode
I, the abovenamed Rail Safety Officer MAKE OATH AND SAY/AFIRM AND DECLARE
1. I am applying for a search warrant to search and seize the following thing/s from the above place:
2. The offence for which this search warrant is sought is pursuant to:
3. The grounds on which this application is made are:
I swear/affirm that the contents of this affidavit are true and correct to the best of my knowledge and belief.
SWORN before me at
on the
day of
20
DX
Signature
.......................................................................
.............................................................
RAIL SAFETY OFFICER
Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
..................................................
..................................................
.......................................................................
Date
MAGISTRATES COURT
Form 97
Search Warrant (Rail Safety National Law (SA) Act 2012, par 150 of the Schedule)
Form 97
SEARCH WARRANT
Court Use

Date Filed:

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Rail Safety Officer

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode
Application made:
Personally
By telephone/facsimile in my opinion, the following facts justify the issue of the warrant:
Terms of the Warrant

I, the undersigned Magistrate, am satisfied that there are reasonable grounds for suspecting that there is, or may be
within the next 72 hours at the place named above, evidence of the commission of the following offence:
I authorise that the above rail safety officer may, with necessary and reasonable help and force, enter the above
place and exercise the powers of the officer, in order to search and seize the following thing(s) of a kind that may be
evidence of the commission of the offence:
In my opinion, the following facts justify the issue of the warrant: (telephone application only)
Entry into this premises is authorised to be made at:

any time of the day and night
between the following hours:
This warrant will cease to have effect on
warrant)
(not later than 7 days after the issue of the
............................................
............................................
..............................................................
Date
MAGISTRATE
Form 98
Duplicate warrant (Rail and Safety National Law (SA) Act 2012, par 150 of the Schedule)
Form 98
DUPLICATE WARRANT
Court Use

Date Filed:

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Rail Safety Officer

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode

The above Magistrate was satisfied following a telephone or facsimile application that there are reasonable grounds
for suspecting that there is, or may be within the next 72 hours at the place named above, evidence of the
commission of the following offence:
The above rail safety officer has been authorised by the above Magistrate, with necessary and reasonable help and
force, enter the above place and exercise the powers of the officer, in order to search and seize the following thing(s)
of a kind that may be evidence of the commission of the offence:

any time of the day and night
between the following hours:
warrant)
............................................
............................................
..............................................................
Date
RAIL SAFETY OFFICER
Form 99
Firearms prohibition order

Form 99
Court Use
FIREARMS PROHIBITION ORDER

Firearms Act 1977

Section 34A
date filed

Registry
.................................................
File No
............................................
Address ...............................................................................................................................................
..........................................
............................................
............................................
telephone
facsimile
e-mail address
Defendant
Details of offence/proceedings:
...................................................
Court File No:

............................
Date: .........................................
Act: ............................................
Section:
.....................................
Name:........................................
surname
...................................................
given name
DOB:.......................................
...
dd/mm/yy
Address:.....................................
...................................................
............................................
street
...................................................
state
city/town/suburb
...................................................
postcode
................................................
...licence number
Complainant
Name:........................................
surname
Address:.....................................
street
...................................................
telephone
...................................................
given name
...................................................
city/town/suburb
...................................................
facsimile
................................................
..Complainants reference
............................................
state
postcode
................................................
...e-mail address
You have been found guilty of the above offence(s) and the court has found that a firearm,
mechanism, fitting or ammunition was involved in the commission of the offence; or

The court has formed the view that you are not a fit and proper person to have possession of a
firearm, mechanism, fitting or ammunition; or
The court is satisfied by evidence adduced before it that:
a firearm or other offensive weapon was used in the commission of the above offence; or
the commission of the above offence was facilitated by the use of a firearm or other
offensive weapon; or
in the circumstances it is expedient that an order or orders be made under section 299A of
the Criminal Law Consolidation Act 1935;
(delete those which do not apply)
AND
The Court has ordered that you are subject to a firearms prohibition order until further order.
This order is subject to the following exemptions from section 10C: . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................................................................
(delete those provisions from notice on rear)
...........................
MAGISTRATES COURT
..................
Date
There is important information on the back of this order

If you breach a term of this order you may be liable for a fine of up to $75 000 or a sentence of
imprisonment of up to 15 years.
The court may exempt you on written application, unconditionally or subject to conditions, from a
specified provision of section 10C.
EFFECT OF A FIREARMS PROHIBITION ORDER

(Section 10C Firearms Act 1977)
You are now disqualified forthwith from obtaining any licence or permit under the Firearms Act.
While a firearms prohibition order is in force against you, any licence or permit you may hold under the
Firearms Act is suspended and section 31A of the Act relating to a period of grace of one month to
enable disposal of any firearms in your possession no longer applies.
You must not acquire, possess or use a firearm, firearm part or ammunition.
You must forthwith surrender to the Registrar all firearms, firearm parts and ammunition owned by
yourself.
You must not be present at the grounds of a firearms club, or the range of a commercial range operator,
or a place at which a person carries on the business of manufacturing, repairing, modifying or testing
firearms, firearm parts or ammunition, or buying, selling or hiring out firearms, firearm parts or
ammunition; or any other place of a kind prescribed by regulation.
You must not become a member of a firearms club.

You must not be in the company of a person who has a firearm on or about his or her person or under
his or her immediate physical control.
You must not reside at premises on which there is a firearm, firearm part or ammunition.
You are required to inform each other person of or over the age of 18 years who resides or proposes to
reside at the same premises as yourself of the fact that a firearms prohibition order is in force against
you and ask each such person whether or not he or she has or proposes to have a firearm, firearm part
or ammunition on the premises.
Any person who supplies you with a firearm, firearm part or ammunition is committing an offence.
Any person who has a firearm, firearm part or ammunition in their immediate physical control or on or
about their person whilst in your company is committing an offence.
Any person who brings a firearm, firearm part or ammunition onto the premises in which you reside is
committing an offence.
PROOF OF SERVICE
Name of deponent:.....................................................................
) ..............................................
of ................. 20......
Application for disclosure of operatives identity in proceedings
Form 100
Form 100
APPLICATION FOR DISCLOSURE OF

OPERATIVES IDENTITY IN
PROCEEDINGS
Court Use

date filed
Criminal Investigation (Covert Operations) Act 2009 Section

40
Registry:
Court File No: .
Name of Parties:
Applicant:
Name: ........................................................... ,
........................................................
Surname
Given Name
Address:.
Street
......................................................
State
City/Town/Suburb
.......................................
..............................................................
Postcode
Phone Number
Witness Protection Certificate

I, the applicant, acknowledge that a witness identity protection certificate in respect of an operative has
been filed in the . court in relation to the proceedings of ......
Order or Relief sought:

Order requiring witness to answer questions/give evidence - section 40(1)(b)
Permission to ask a question of a witness (including the operative) section 40(1)(a)(ii)
Permission for a person involved in the proceedings to make a statement section 40(1)(a)(ii)
Details:
Date: .................................................
Hearing
Date Registry: ......................................................................
Time: .................................... am/pm

Address ......................................................................
...........................................................................
Telephone
..........................................
....................................................................
Facsimile
..........................................................................................
.................................................................................
E-mail Address
Date
Registrar
I certify that I have served a copy of this application on all parties to this proceeding.
Date:
Signature:
...
(Applicant)
Form 101
Suppression order
Form 101
SUPPRESSION ORDER
Criminal Investigation (Covert Operations) Act 2009 Section 40(6)
Name
of Parties:
..
Name
of Parties:
File Number: .
Court and Location:
Charge(s): ...
Before:.
Details of this Order:

Suppression of the publication of
anything said during the course of an application under section 40;
AND
If permission is given, or an order is made in response to an application under section 40, evidence or
information that discloses or may lead to the disclosure of the operatives identity or place of residence.
Details to be suppressed: ..
Pursuant to Section 40(7) of the said Act I make the following further orders to protect the operatives
identity or to prevent the disclosure of the operatives place of residence.
1. *Delete if inapplicable
DATE OF ORDER://
REGISTRY OF ISSUE:
Magistrate
Form 102A
Notice of intention by the prosecution authority to adduce evidence of discreditable conduct

Form 102A
NOTICE OF INTENTION BY THE PROSECUTING AUTHORITY

TO ADDUCE EVIDENCE OF DISCREDITABLE CONDUCT
Evidence Act 1929

Section 34P(4)
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Prosecuting Authority Giving Notice

Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
To Defendant/s
Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
Name
State
Surname
Postcode
Email Address
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
Name
State
Surname
Postcode
Email Address
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
The above named Prosecuting Authority gives notice of its intention at trial to seek to adduce evidence of
discreditable conduct of the Defendant,
and provides the following particulars.
1.
The nature of the discreditable conduct:
2.
The witness or witnesses from whom the evidence is to be led:
3.
The fact or facts in issue in respect of which the evidence of discreditable conduct relate/s is circumstantial
evidence under s 34P(2)(b):
..................................................
.......................................................................
Date
Prosecuting Authority
Note: If you wish to object to the admission of the evidence of discreditable conduct proposed to be adduced by
the Prosecuting Authority you must, within 28 days of the filing of this Notice, file in this Court and serve on all
other parties to the proceedings a Notice using Form 102C which sets out the grounds of your objection.
Form 102B
Notice of intention by a defendant to adduce evidence of discreditable conduct

Form 102B
NOTICE OF INTENTION BY A DEFENDANT TO ADDUCE

EVIDENCE OF DISCREDITABLE CONDUCT
Evidence Act 1929

Section 34P(4)
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Defendant Giving Notice

Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
To Prosecuting Authority
Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
And to other Defendant/s

Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
Name
State
Surname
Postcode
Email Address
Given name/s
Street
Telephone
Address
City/Town/Suburb
State
Postcode
Email Address
Facsimile
The Defendant,
gives notice of his/her intention at trial
to seek to adduce evidence of discreditable conduct of Co-defendant,
and provides the following particulars.
4. The nature of the discreditable conduct:
5.
The witness or witnesses from whom the evidence is to be led:
..................................................
..................................................
.......................................................................
Date
Defendant
Note: This notice must be filed in the Court and served on all other parties to the proceedings at least 21 days
before the listed trial date.
Form 102C
Notice of objection to proposed evidence of discreditable conduct

Form 102C
NOTICE OF OBJECTION TO PROPOSED EVIDENCE OF

DISCREDITABLE CONDUCT
Evidence Act 1929

Section 34P(4)
Registry
File No
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
Objecting Party
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
The above named party will object to the evidence of discreditable conduct proposed to be
adduced by the party named below
Name
Surname
Given name/s
Address
Street
City/Town/Suburb
Telephone
State
Facsimile
Postcode
Email Address
The grounds of objection are:
............................................
Date
..............................................................
Prosecuting Authority / Defendant
Note: This Notice must be filed in the Court and served on all other parties to the proceedings at least 7 days before
the listed trial date.
Form 103
Application for warrant (Correctional Services Act 1982 s 76 or 76A)

Form 103
APPLICATION FOR WARRANT
Court Use

Correctional Services Act 1982
Date Filed:
Sections 76 or 76A
Application made:
personally
by telephone
by facsimile
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Applicant
Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Parolee
Name
DOB
Surname
Given name/s
dd/mm/yyyy
Street
Address
City/Town/Suburb
State
Postcode
The applicant applies for:

a warrant for the arrest of the parolee; or
a warrant for the arrest and return to prison of the parolee
Grounds on which the application is made:
Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
............................................
............................................
..............................................................
Date
MAGISTRATES COURT
Form 104
Warrant (Correctional Services Act 1982 s76 or 76A)

Form 104
WARRANT
Court Use
Date Filed:

Sections 76 or 76A
Application made:
personally
by telephone
by facsimile
Registry
Address
File No
Street
Telephone
City/Town/Suburb
State
Postcode
Facsimile
DX
Email Address
Applicant
Name
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Parolee
DOB
Name
Surname
Given name/s
dd/mm/y
yyy
Street
Address
City/Town/Suburb
State
Postcode

I, the undersigned Magistrate, authorise:
the arrest of the parolee; or
the arrest and return to prison of the parolee
............................................
............................................
..............................................................
Date
MAGISTRATE
Form 105
Order upon notification

Form 105
ORDER UPON NOTIFICATION
Court Use

Date Filed:
Section 76B
Registry
Address
File No
Street
Telephone
City/Town/Suburb
State
Postcode
Facsimile
DX
Email Address
Parolee
DOB
Name
Surname
Given name/s
dd/mm/yyy
y
Street
Address
City/Town/Suburb
State
Postcode
Terms of the order

I, the undersigned Magistrate, direct that the abovenamed parolee be detained in a correctional institution pending attendance before the Board; or
be released and summoned to attend before the Board; or
be released from detention.
............................................
............................................
..............................................................
Date
MAGISTRATE
Form 106
Interim non-association order and/or place-restriction order and summons

Form 106
INTERIM NON-ASSOCIATION ORDER and/or

PLACE-RESTRICTION ORDER and SUMMONS

Section 80(2)

AP Number
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Applicant
Full Name
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Rank and ID No.
Defendant
DOB
Full Name
dd/mm/
yyyy
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Date order made:

The Court has heard an application for a Non-Association order and/or a Place Restriction order (strike out
inapplicable) in your absence.
In the 2 years immediately preceding the making of the complaint you had been convicted of an indictable
offence.
The Court is satisfied that it was reasonably necessary to make this order to ensure you do not commit any further
indictable offences.
Details of Non-Association order:

be in the company of:
Name
Date of birth
Name
Date of birth
Name
Date of birth
communicate with:
Name
Date of birth
Name
Date of birth
Name
Date of birth
except during the following times or circumstances:
Details of Place-Restriction order:

frequent or visit:
Address
Address
Address
Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
............................................
............................................
..............................................................
Date
MAGISTRATES COURT

Non-compliance with the order renders you liable to a term of imprisonment not exceeding 6 months for
a first offence and not exceeding 2 years for a subsequent offence
If you do not appear, an order may be made in your absence

I,
of
Occupation:
I.
I did on the
day of
20
serve the within named defendant
, between the hours of
and
duly
with this claim and Form 17 and any applicable form
under the Service and Execution of Process Act 1992 (Cth).

(Please tick the appropriate box)
By personal service on the person.

By service on the solicitor acting for the person.
By leaving it for the person at the address of the place of dwelling or business of the person with someone
apparently above the age of 14 years.
By depositing it for the person at the DX addressed to the DX number of the person or the solicitor acting for
the person.
By leaving it at the registered office of the body corporate.
By sending it by prepaid post addressed to the strata corporation at its site or its post office box.
By prepaid post addressed to the community corporation or to the presiding officer, treasurer or secretary at
the postal address of the community corporation or by placing it in the community corporations letterbox.
By fax directed to the fax number of the person or the solicitor acting for the person during normal business
hours on a business day.
By service on one partner or at the principal place of business of the firm.
By sending it by prepaid post addressed to the person at (note - unless the court is satisfied that the document served by this method came to the attention of the
defendant the plaintiff is not entitled to costs thrown away if the judgment is set aside-rule 106(8))
By
(here describe any other authorised means of service)
II.
I served the person at (state the address, DX number, fax number etc.)
III.
I necessarily made
SWORN before me at
Signature
trips and travelled
kilometres for the purpose of effecting the service.

the
day of
20
.......................................................................
.............................................................
SERVER
Form 107
Non-association order and/or place-restriction order

Form 107
NON-ASSOCIATION ORDER and/or

PLACE-RESTRICTION ORDER

Section 80(1)

AP Number
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Applicant
Full Name
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Rank and ID No.
Defendant
DOB
Full Name
dd/mm/yy
yy
Street
Telephone
Address
City/Town/Suburb
State
Postcode
Email Address
Facsimile
Details of Non-Association order:

be in the company of:
Name
Date of birth
Name
Date of birth
Name
Date of birth
communicate with:
Name
Date of birth
Name
Date of birth
Name
Date of birth
Details of Place-Restriction order:

frequent or visit:
Address
Address
Address
This order will commence on:

and will expire on:
............................................
............................................
..............................................................
Date
MAGISTRATES COURT

Non-compliance with the order renders you liable to a term of imprisonment not exceeding 6 months for a
first offence and not exceeding 2 years for a subsequent offence

I,
of
Occupation:
I.
I did on the
day of
20
serve the within named defendant
, between the hours of
and
duly
with this claim and Form 17 and any applicable form
under the Service and Execution of Process Act 1992 (Cth).

(Please tick the appropriate box)
By personal service on the person.

By service on the solicitor acting for the person.
By leaving it for the person at the address of the place of dwelling or business of the person with someone
apparently above the age of 14 years.
By depositing it for the person at the DX addressed to the DX number of the person or the solicitor acting for
the person.
By leaving it at the registered office of the body corporate.
By sending it by prepaid post addressed to the strata corporation at its site or its post office box.
By prepaid post addressed to the community corporation or to the presiding officer, treasurer or secretary at
the postal address of the community corporation or by placing it in the community corporations letterbox.
By fax directed to the fax number of the person or the solicitor acting for the person during normal business
hours on a business day.
By service on one partner or at the principal place of business of the firm.
By sending it by prepaid post addressed to the person at (note - unless the court is satisfied that the document served by this method came to the attention of the
defendant the plaintiff is not entitled to costs thrown away if the judgment is set aside-rule 106(8))
By
(here describe any other authorised means of service)
II.
I served the person at (state the address, DX number, fax number etc.)
III.
I necessarily made
SWORN before me at
Signature
trips and travelled
kilometres for the purpose of effecting the service.

the
day of
.......................................................................
20
.............................................................
SERVER
Form 108
Application for variation or revocation of non-association order and/or place-restriction order

Form 108
APPLICATION FOR VARIATION OR REVOCATION

OF NON-ASSOCIATION ORDER and/or
PLACE-RESTRICTION ORDER

Section 82(1)
AP Number
Registry
File No
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Applicant
Full Name
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Rank and ID No.
Defendant
DOB
Full Name
dd/mm/yy
yy
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address

Non-Association order made on file number:
dated:
Place-Restriction order made on file number:
dated:
The applicant seeks to have the order:

varied
revoked
Details of variations sought:
Hearing details
Registry
Date
Address
Time
am/pm
Telephone
Facsimile
Email Address
............................................
............................................
..............................................................
Date
MAGISTRATES COURT
Form 109
Publication Order
Form 109
PUBLICATION ORDER
Court Use

Evidence Act 1929
Date Filed:
Section 71A
Registry
Action No
Address
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Defendant
DOB
Full Name
dd/mm
/yyyy
Surname
Street
Address
City/Town/Suburb
State
Postcode
Details of this Publication Order

The restriction on publishing information about the sexual offence/s with which the defendant has been charged is
varied or removed as follows:
This order expires upon the defendant being committed to a higher court or when the charge/s is
dismissed/discontinued.
............................................
..............................................................
Date
MAGISTRATE
Form 110
Application for spent conviction order and/or exemption order

Form 110
APPLICATION FOR SPENT CONVICTION ORDER

and/or EXEMPTION ORDER
Court Use
Date Filed:

Date Posted:
Spent Convictions Act 2009
Service on the
Section 8A and 13A
Attorney-General
Service on the
Commissioner of
Police:
Registry
Action No
Street
Telephone
Facsimile
DX
Address
City/Town/Suburb
State
Postcode
Email Address
Applicant
DOB
Full Name
dd/mm/yyyy
Street
Telephone
Facsimile
DX
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Spent Conviction Application

The applicant is applying to have the following eligible sex offence/s spent:
First offence
Offence (including the statutory provision of the offence):
Court name where the conviction was recorded:

Date the conviction was recorded:
Penalty that was imposed:
Second offence

Details of any further information that the applicant would like to submit in support of the application (circumstances
and seriousness of offence, the circumstances of the applicant etc.)
Has an application been made to spend any of the above convictions in the preceding 2 years?
Yes
No
If yes, please provide the following details:

The conviction the application was in regard to:
The application was made on the
The application was refused on the
day of
day of
Any further information the applicant considers relevant
20
20
Details of Exemption Application

The applicant is applying to have the following spent conviction/s exempt:
First offence
For the purpose/s of:
working with, or caring for, children (sch 1, cl 6)
working with, or caring for, vulnerable people (sch 1, cl 7)
activities associated with a character test (sch 1, cl 8)
Second offence
Details of any further information that the applicant would like to submit in support of the application (circumstances
and seriousness of offence, the circumstances of the applicant etc.)
Has an application been made to exempt any of the above spent convictions in the preceding 2 years?
Yes
If yes, please provide the following details:

The conviction the application was in regard to:
The application was made on the
The application was refused on the
day of
day of
20
20
Any further information the applicant considers relevant
............................................
..............................................................
Date
APPLICANT
Hearing
details
Registry
Date
Address
Time
Telephone
Facsimile
am/pm
Email Address
NOTICE TO APPLICANT
If you have any transcript or sentencing remarks made in connection with the above conviction/s these must be
attached to the application. You do not need to attend the hearing unless you are notified to do so by the Registrar.
No
NOTICE TO THE ATTORNEY-GENERAL, COMMISSIONER OF POLICE AND DESIGNATED MINISTER

If you wish to intervene and request a hearing in these proceedings you must notify the applicant and the Registrar in
writing 7 days before the hearing date.
A copy of this application must be served on the Attorney-General and the Commissioner of Police at least 4 weeks
before the day appointed for hearing the application.
If an exemption order application is made:
for the purpose of working with, or caring for children, the Minister for Childrens Protection must also be served a
copy of this application at least 4 weeks before the day appointed for hearing the application.
2. for the purpose of working with, or caring for vulnerable people, the Minister for Disabilities must also be served a
copy of this application at least 4 weeks before the day appointed for hearing the application.
Where a qualified Magistrate requires the attendance of the applicant, all potential parties must be notified at least 7 days
prior to the hearing date.
1.
Form 111
Spent conviction order and/or exemption order

Form 111
SPENT CONVICTION ORDER and/or EXEMPTION

ORDER
Court Use

Date Filed:
Spent Convictions Act 2009

Section 8A and 13A
Registry
Address
Action No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Applicant
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Details of Spent Conviction Order

The applicants following conviction/s will be spent:
First offence
Second offence
Details of Exemption Order

The applicants following spent conviction/s will be exempt:
First offence
Postcode
Email Address
Facsimile
DX

Second offence
.............................................
.............................................
...............................................................
Date
MAGISTRATE
Form 112
Application for warrant (heavy Vehicle National Law (SA) Act 2013, Clause 506 of the
Schedule)
Form 112
Court Use

Heavy Vehicle National Law (South Australia) Act 2013
Date Filed:
Clause 506 of the Schedule

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode
Details of person suspected of committing the offence/s (if known)

Name
Surname
Given name/s
I, the abovenamed authorised officer MAKE OATH AND SAY/DO TRULY AND SOLEMNLY AFFIRM
4. I am applying for a warrant to enter the above place, exercise the powers of an authorised officer, including
search powers and seize the following evidence from the above place:
5. The offence/s for which this warrant is sought is pursuant to:
DX
6. The grounds on which this application is made are:
SWORN/AFFIRMED before me at
on the
day of
Signature
20
.......................................................................
.............................................................
AUTHORISED OFFICER
Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
..................................................
..................................................
.......................................................................
Date
MAGISTRATES COURT
Form 113
Warrant (Heavy Vehicle National Law (SA) Act 2013, Clause 507 of the Schedule)
Form 113
WARRANT
Court Use

Date Filed:

Name of Authorised Warrant Official issuing warrant:
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode

Name
Surname
Given name/s
Application made:
Personally
By radio/telephone/fax/email/video conference/another form of electronic communication I am satisfied that it
was necessary to make the application in a way, other than in person, because of urgent circumstances or other
special circumstances, namely:

I, the undersigned Authorised Warrant Official, am satisfied that there are reasonable grounds for suspecting that
there is, or may be within the next 72 hours, at the place named above a particular thing or activity that may provide
evidence of the commission of the following offence/s:
I authorise that the above authorised officer, or any authorised officer may, with necessary and reasonable help and
force, enter the above place and any other place necessary for entry, and exercise the powers of the officer,
including search powers, and seize the following thing/s of a kind that may be evidence of the commission of the
offence/s:
Entry into the place is authorised to be made between the following hours:
Date and time the warrant was issued:
This warrant ends on
warrant)
.............................................
.............................................
...............................................................
Date
AUTHORISED WARRANT OFFICIAL
Form 114 Duplicate warrant (Heavy Vehicle National Law (SA) Act 2013, Clause 508 of the Schedule
Form 114
DUPLICATE WARRANT
Court Use

Date Filed:

Name of Authorised Warrant Official issuing warrant:
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place
Street
Address
City/Town/Suburb
State
Postcode

Name
Surname
Given name/s
This application was made by radio/telephone/fax/email/video conference/another form of electronic communication

and the above Authorised Warrant Official was satisfied that it was necessary to make the application in a way,
other than in person, because of urgent circumstances or other special circumstances, namely:
and that the way the application was made was appropriate.
The above Authorised Warrant Official was satisfied following an application by radio/telephone/fax/email/video
conference/another form of electronic communication that there are reasonable grounds for suspecting that there is,
or may be within the next 72 hours, at the place named above a particular thing or activity that may provide
evidence of the commission of the following offence/s:
The above authorised officer, or any authorised officer, has been authorised by the above Authorised Warrant
Official, with necessary and reasonable help and force, to enter the above place and any other place necessary for
entry, and exercise the powers of the officer, including search powers, and seize the following thing/s of a kind that
may be evidence of the commission of the offence/s:
Entry into the place is authorised to be made between the following hours:
Date and time the warrant was issued:
This warrant ends on
warrant)
.............................................
.............................................
...............................................................
Date
AUTHORISED OFFICER
Form 115
Affidavit
Form 115
Court Use
AFFIDAVIT
Date Filed:
Registry
Address
Action No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Facsimile
DX
Facsimile
DX
Email Address
Defendant
Full Name
Address
Street
City/Town/Suburb
Telephone
State
Postcode
Email Address
Deponent
Full Name
Occupation
Address
Street
City/Town/Suburb
Telephone
State
Postcode
Email Address
I, the abovenamed deponent MAKE AN OATH AND SAY / DO TRULY AND SOLEMELY AFFIRM:
I, the abovenamed deponent, swear/affirm that the contents of this affidavit are true and correct to the best of my
knowledge and belief.
SWORN before me at
on the
day of
20
Signature
.......................................................................
.............................................................
DEPONENT
Form 116 Application for enforcement warrant (Marine Safety (Domestic Commercial Vessel) Nation
Law (Application) Act 2013, Schedule 1, Clause 135)
Form 116
APPLICATION FOR ENFORCEMENT WARRANT
Court Use

Marine Safety (Domestic Commercial Vessel) National Law

(Application)Act 2013
Date Filed:
Schedule 1, Clause 135

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address
Marine Safety Inspector

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
State
Postcode
I, the abovenamed marine safety inspector MAKE OATH AND SAY/DO TRULY AND SOLEMNLY AFFIRM
7. I am applying for an enforcement warrant to enter the above premises, exercise the powers of an inspector set
out in ss 103, 105, 106, 107, 130 and division 5, and seize the following evidential material from the above
premises:
8. The offence/s for which this warrant is sought is pursuant to:
9. The grounds on which the warrant is sought are:
SWORN/AFFIRMED before me at
on the
day of
20
Signature
.......................................................................
.............................................................
MARINE SAFETY INSPECTOR
Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
..................................................
..................................................
.......................................................................
Date
MAGISTRATES COURT
Form 117
Enforcement warrant (Marine Safety (Domestic Commercial Vessel) National Law

(Application) Act 2013, Schedule 1, Clause 135
Form 117
ENFORCEMENT WARRANT
Court Use


Date Filed:

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
DX
Email Address

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
State
Postcode

Name
Surname
Given name/s
Application made:
Personally
By telephone/facsimile/other electronic means I am satisfied that there are reasonable grounds for issuing this
warrant urgently, namely:

I, the undersigned Magistrate, am satisfied that there are reasonable grounds for suspecting that there is, or may be
within the next 72 hours, at the premises named above, evidential material that may provide evidence of the
commission of the following offence/s:
I authorise that the above marine safety inspector, and the following marine safety inspector/s
may enter the above premises and any other premises necessary for entry, and exercise the powers of the inspector
as set out in ss 103, 105, 106, 107, 130 and division 5, and seize the following thing/s of a kind that may be evidence
of the commission of the offence/s:

any time of the day:
between the following hours of the day:
Date and time the warrant was signed:
warrant)
.............................................
.............................................
...............................................................
Date
MAGISTRATE
Form 118
Duplicate warrant (Marine Safety (Domestic Commercial Vessel) National

Law (Application) Act 2013, Schedule 1, Clause 136)
Form 118
DUPLICATE WARRANT
Court Use

Date Filed:

Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
Email Address

Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Premises
Street
Address
City/Town/Suburb
State

Name
Surname
Given name/s
Postcode
DX
This application was made by telephone/facsimile/other electronic means and the above magistrate was satisfied
that there are reasonable grounds for issuing this warrant urgently, namely:

The above magistrate was satisfied following an application by telephone/facsimile/other electronic means that
there are reasonable grounds for suspecting that there is, or may be within the next 72 hours, at the premises
named above, evidential material that may provide evidence of the commission of the following offence/s:
The above marine safety inspector, and the following marine safety inspector/s
have been authorised by the above magistrate to enter the above premises and any other premises necessary for
entry, and exercise the powers of the inspector as set out in ss 103, 105, 106, 107, 130 and division 5, and seize
the following thing/s of a kind that may be evidence of the commission of the offence/s:

any time of the day:
between the following hours of the day:
Date and time the warrant was signed:
warrant)
.............................................
.............................................
...............................................................
Date
MARINE SAFETY INSPECTOR
Form 119
Application for warrant (Burial and Cremation Act 2013)

Form 119
Court Use

Burial and Cremation Act 2013
Date Filed:
Section 59
Burial and Cremation Regulations 2014

Regulation 38
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place, Vessel or Vehicle

Street
Address
City/Town/Suburb
Vessel or
Vehicle
Vehicle Type/Model
Details of documents to be produced:
Purpose for which the warrant is required:
State
Postcode
Registration Number
DX
Grounds on which the warrant is sought:

Registry
Hearing details
Date
Time
Address
Telephone
am/pm
Facsimile
Email Address
..................................................
..................................................
.......................................................................
Date
MAGISTRATES COURT
Form 120
Warrant (Burial and Cremation Act 2013)

Form 120
WARRANT
Court Use

Burial and Cremation Act 2013
Date Filed:
Section 59
Burial and Cremation Regulations 2014

Regulation 38
Registry
Address
File No
Street
City/Town/Suburb
Telephone
State
Postcode
Facsimile
Email Address
Authorised Officer
Name
ID No.
Surname
Given name/s
Street
Telephone
Facsimile
Address
City/Town/Suburb
State
Postcode
Email Address
Details of Place, Vessel or Vehicle

Street
Address
City/Town/Suburb
Vessel or
Vehicle
State
Vehicle Type/Model
Details of documents to be produced:
Application made:
Personally
By telephone in my opinion, the following facts justify the issue of the warrant:
The authorised officer undertakes to forward an affidavit verifying the facts relied on above.
Postcode
Registration Number
DX

I, the undersigned Magistrate, am satisfied that there are reasonable grounds for believing that:
a contravention of this Act has been, is being, or is about to be, committed in or on the place, vessel or vehicle;
or
something may be found in or on the place, vessel or vehicle that has been used in , or constitutes evidence
of, a contravention of this Act; or
that the circumstances require immediate attention.
I authorise that the above authorised officer may, with necessary and reasonable help and force, enter the above
place, vessel or vehicle and exercise the powers of the authorised officer as set out in s 59 of the Act, including
seizing and retaining anything that the authorised officer reasonably suspects has been used in, or may constitute
evidence of, a contravention of this Act and/or require documents specified above to be produced.
(not later than 48 hours after the issue of the warrant)
..................................................
..................................................
.......................................................................
Date
MAGISTRATE

Approved Forms (Magistrates Court Criminal Rules 1992)

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Approved Forms (Magistrates Court Criminal Rules 1992)

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South Australia

Approved Forms relating to Magistrates Court Criminal Rules 1992.

Application for release on bail ....................................................................................................................... 6

Application for review of bail by Magistrate ................................................................................................... 7

Application to vary or revoke bail .................................................................................................................. 9

Application to vary conditions of or revoke bail agreement .......................................................................11

Application to vary terms of or revoke guarantee of bail ...........................................................................13

complaint and summons .............................................................................................................................16

Complaint and summons with form for plea ...............................................................................................19

Information and summons ..........................................................................................................................25

Form 05A Summons........................................................................................................................................................28

Warrant of apprehension ..............................................................................................................................34

Warrant of remand ......................................................................................................................................36

Form of election ...........................................................................................................................................38

Admission and consent t sentence ..............................................................................................................42

Order of committal ......................................................................................................................................44

Summons to witness ....................................................................................................................................45

Warrant to arrest witness ............................................................................................................................49

Notice to produce person from custody......................................................................................................53

Form 15A Summons to person substantially affected...................................................................................................58

Notice of order of forfeiture, destruction, compensation etc.....................................................................61

Notice of previous convictions.....................................................................................................................64

Notice of penalty .........................................................................................................................................66

Application for rehearing ...............................................................................................................................67

Notice of committal on written plea of guilty .............................................................................................69

Application to vary a community service order ...........................................................................................76

Warranty of commitment - contempt .........................................................................................................81

Request for registration of order .................................................................................................................83

Warrant of distress against body corporate registered order ..................................................................85

Authority to enter and inspect section 22 Magistrates Court Act ............................................................88

Application for intervention order...............................................................................................................89

Form 28A Complaint (paedophile restraining order) ...................................................................................................... 3

Interim intervention summons order ............................................................................................................ 6

Form 29A Summons (paedophile restraining order) .....................................................................................................10

Intervention order .......................................................................................................................................16

Application for variation or revocation of intervention order ....................................................................20

Application to revoke restraining order ......................................................................................................30

Restraining order as varied ..........................................................................................................................33

Order revoking restraining order .................................................................................................................36

Notice of not guilty hearing .........................................................................................................................37

Problem gambling order ..............................................................................................................................40

Notice of problem gambling attachment order ..........................................................................................41

Notice of intention to assign tenancy ..........................................................................................................42

Tenancy Order .............................................................................................................................................44

Application to vary or revoke a problem gambling order or tenancy order ................................................45

Request to register foreign intervention order ...........................................................................................46

Request to register foreign intervention order ...........................................................................................47

Notice of registration of foreign intervention order ...................................................................................48

Multilingual notice .......................................................................................................................................49

Application for extension of period of detention ........................................................................................52

Affidavit (intervention order) ......................................................................................................................53

Order for variation or revocation of intervention order .............................................................................55

Application for a control order ....................................................................................................................56

Interim control order and summons ...........................................................................................................57

Control order ...............................................................................................................................................59

Application for variation or revocation of

control order or interim control order ................................................

Application for warrant (Animal Welfare Act) .............................................................................................64

Warrant (Animal Welfare Act s.31D) ...........................................................................................................66

Duplicate warrant (Animal Welfare Act s.31D)............................................................................................68

Appeal of enforcement determination........................................................................................................70

Application for community service order ....................................................................................................71

Application to revoke community service order ...........................................................................................72