Details of the applicant (the person making the application)
Name—
Police application number (if application made by police)—
Contact details—
Details of the protected person or persons (the persons to be protected by the order)
Name of first person—
Date of birth/Age—
Address—
Name of any other person—
Date of birth/Age—
Address—
Note—
The address at which a protected health care provider resides must not be stated in this application unless the protected health care provider consents to the address being included or, if the application is made by a police officer, the police officer is satisfied that the defendant knows the address. See the Crimes (Domestic and Personal Violence) Act 2007, section 44.
Details of the defendant (the person against whom the order is sought)
The maximum penalty for that offence is imprisonment for 12 months or a fine of $1,100, or both.
NOTICE TO DEFENDANT
You are directed to attend the Local Court or Children’s Court of NSW on—
Date—
Time—
at
Place—
If you fail to attend, the court may make orders against you or issue a warrant for your arrest to bring you before the court.
Reasons for making this application
The applicant is making an application for an apprehended personal violence order for the following reasons—
Further information about the relationship between the applicant and the defendant
Note—
In this section, references to “you” refer to the persons to be protected by the order. This section is not required to be completed if this application is made by the police.
Schedule Schedule 1 - Crimes (Domestic and Personal Violence) Regulation 2025 - Application notices for apprehended violence orders | Zoe
| 1 | Is there an existing commercial relationship between you and the defendant? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 2 | Do you owe the defendant any money? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 3 | Do you owe any other financial debt to the defendant? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 4 | Does the defendant owe you any money? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 5 | Does the defendant owe any other financial debt to you? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 6 | Has there ever been a court case or legal proceedings involving you and the defendant? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
The applicant asks that the court make the following orders against the defendant for a period of [insert number] months—
The standard orders that the applicant asks the court to make
| Orders about behaviour |
| 1 | The defendant must not do any of the following to the protected person(s) or anyone the protected person(s) has a domestic relationship with— |
| | (a) | assault or threaten them, |
| | (b) | stalk, harass or intimidate them, |
| | (c) | intentionally or recklessly destroy or damage any property or harm an animal that belongs to them or is in their possession. |
Additional orders that the applicant asks the court to make (tick if required)
| Orders about contact |
| □ 2 | The defendant must not approach or contact the protected person(s) in any way, unless contact is through a lawyer. |
| □ 3 | The defendant must not approach— |
| | □ (a) | the school or any other place the protected person(s) might go to for study, or |
| | □ (b) | any place the protected person(s) might go to for childcare, or |
| | □ (c) | any other place listed here— |
| □ 4 | The defendant must not approach or be in the company of the protected person(s) within 12 hours after drinking alcohol or taking illicit drugs. |
| □ 5 | The defendant must not try to find the protected person(s), except as ordered by a court. |
| Orders about family law and parenting |
| 6 | This order is not applicable to apprehended personal violence orders. |
| Orders about where defendant cannot go |
| □ 7 | The defendant must not live at— |
| | □ (a) | the same address as the protected person(s), or |
| | □ (b) | any place listed here— |
| □ 8 | The defendant must not go into— |
| | □ (a) | any place where the protected person(s) lives, or |
| | □ (b) | any place where the protected person(s) works, or |
| | □ (c) | any place listed here— |
| □ 9 | The defendant must not go within [insert number] metres of— |
| | □ (a) | any place where the protected person(s) lives, or |
| | □ (b) | any place where the protected person(s) works, or |
| | □ (c) | any place listed here— |
| Order about weapons |
| □ 10 | The defendant must not possess any firearms or prohibited weapons. |
| Other orders |
| □ 11 | [List other orders]. |
Signature of the applicant—
Date—
Form 2 Application for apprehended domestic violence order
Details of the applicant (the person making the application)
Name—
Police application number (if application made by police)—
Contact details—
Details of the protected person or persons (the persons to be protected by the order)
Name of first person—
Date of birth/Age—
Address—
Relationship to defendant—
Name of any other person—
Date of birth/Age—
Address—
Note—
The address at which a protected person resides must not be stated in this application unless the protected person is 16 years of age or more and consents to the address being included or, if the application is made by a police officer, the police officer is satisfied that the defendant knows the address. See the Crimes (Domestic and Personal Violence) Act 2007, section 43.
Details of the defendant (the person against whom the order is sought)
Name—
Date of birth/Age—
Telephone number—
Address—
Central Name Index (if known)—
NOTICE TO DEFENDANT
You are directed to attend the Local Court or Children’s Court of NSW on—
Date—
Time—
at
Place—
If you fail to attend, the court may make orders against you or issue a warrant for your arrest to bring you before the court.
Reasons for making this application and the duration sought
The applicant is seeking an apprehended domestic violence order for a period of [insert number] years.
The reasons the applicant is making an application for an apprehended domestic violence order and seeks the period specified above are as follows—
Further information about the relationship between the applicant and the defendant
Note—
In this section, references to “you” refer to the persons to be protected by the order. This section is not required to be completed if this application is made by the police.
| 1 | Are you currently involved in any legal proceedings under the Family Law Act 1975 of the Commonwealth that may be relevant? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 2 | Has the court made a property order or are property orders currently being sought under the Family Law Act 1975 of the Commonwealth that may be relevant? | Yes □ | No □ |
| | If the answer is “Yes”, give details— | | |
| 3 | Has the court made a parenting order under the Family Law Act 1975 of the Commonwealth that affects this application? | Yes □ | No □ |
| | If the answer is “Yes”—On what basis was the parenting order made—Why should the court intervene with that parenting order— | | |
The applicant asks that the court make the following orders against the defendant—
The standard orders that the applicant asks the court to make
| Orders about behaviour |
| 1 | The defendant must not do any of the following to the protected person(s) or anyone the protected person(s) has a domestic relationship with— |
| | (a) | assault or threaten them, |
| | (b) | stalk, harass or intimidate them, |
| | (c) | intentionally or recklessly destroy or damage any property or harm an animal that belongs to them or is in their possession. |
Additional orders that the applicant asks the court to make (tick if required)
| Orders about contact |
| □ 2 | The defendant must not approach or contact the protected person(s) in any way, unless contact is through a lawyer. |
| □ 3 | The defendant must not approach— |
| | □ (a) | the school or any other place the protected person(s) might go to for study, or |
| | □ (b) | any place the protected person(s) might go to for childcare, or |
| | □ (c) | any other place listed here— |
| □ 4 | The defendant must not approach or be in the company of the protected person(s) within 12 hours after drinking alcohol or taking illicit drugs. |
| □ 5 | The defendant must not try to find the protected person(s), except as ordered by a court. |
| Orders about family law and parenting |
| □ 6 | The defendant must not approach or contact the protected person(s) in any way, unless contact is— |
| | □ (a) | through a lawyer, or |
| | □ (b) | to attend accredited or court-approved counselling, mediation or conciliation, or |
| | □ (c) | ordered by this court or another court about contact with the child/children, or |
| | □ (d) | as agreed in writing between the defendant and the parent(s) about contact with the child/children, or |
| | □ (e) | as agreed in writing between the defendant, the parent(s) and the person with parental responsibility for the child/children about contact with the child/children.Note—Order 6(e) is an alternative to order 6(d). |
| Orders about where defendant cannot go |
| □ 7 | The defendant must not live at— |
| | □ (a) | the same address as the protected person(s), or |
| | □ (b) | any place listed here— |
| □ 8 | The defendant must not go into— |
| | □ (a) | any place where the protected person(s) lives, or |
| | □ (b) | any place where the protected person(s) works, or |
| | □ (c) | any place listed here— |
| □ 9 | The defendant must not go within [insert number] metres of— |
| | □ (a) | any place where the protected person(s) lives, or |
| | □ (b) | any place where the protected person(s) works, or |
| | □ (c) | any place listed here— |
| Order about weapons |
| □ 10 | The defendant must not possess any firearms or prohibited weapons. |
| Other orders |
| □ 11 | [List other orders]. |