Commonwealth of AustraliaCommonwealth of Australia

Commonwealth of Australia

Defence Act 1903

TO each member or special member of the Australian Federal Police, each member of the police force of a State or Territory and each member of the Defence Force.

WHEREAS section 116F of the Defence Act 1903 provides that where the designated authority of a country in relation to which that section applies, by writing signed by him, requests an officer authorized by the Chief of the Defence Force or a service chief, by order in writing, for
the purposes of Division 3 of Part IXA of that Act for assistance in
the apprehension of a member of the forces of that country, not being
an Australian citizen, who is an absentee without leave from those
forces, the authorized officer may, in his discretion, issue a warrant in accordance with the prescribed form authorizing a member or a special member of the Australian Federal Police or a member of the police force of a State or Territory or any member of the Defence Force to arrest that absentee:

AND WHEREAS , the Chief of the Defence Force or a service chief, by order in writing dated , authorized me for the purposes of Division 3 of Part IXA of that Act:

AND WHEREAS the designated authority of , a country to which section 116F of the Defence Act 1903 applies, has, by writing signed by him, made a request to me for assistance in the apprehension of a member of the forces of that country, being a person described in the Schedule, who is an absentee without leave from those forces:

AND WHEREAS that person is not an Australian citizen:

NOW THEREFORE I, , an officer of the Army/Air Force/Navy, by this warrant authorize you to arrest the person described in the Schedule.

SCHEDULE

<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; page-break-after:avoid"><span>Full name:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; page-break-after:avoid"><span>Rank:</span></p></td><td style="width:4.3%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; page-break-after:avoid"><span></span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; page-break-after:avoid"><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Number:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Unit or station:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Date of birth:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Citizenship:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Race:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="4" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Height:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Weight:</span></p></td><td colspan="3" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Build:</span></p></td><td colspan="3" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Complexion:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Colour of eyes:</span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Colour of hair:</span></p></td><td style="width:9.48%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="3" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p><p><span>Other distinguishing marks or features:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="3" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p><p><span>Date on which and place from which</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p><p><span>absented himself</span></p></td></tr><tr><td style="width:31.1%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>without leave:</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>Dated this</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>day of</span></p></td><td colspan="4" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span>, 19</span><span> </span><span>.</span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td style="width:31.1%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p><span></span></p></td></tr><tr><td style="width:31.1%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt"><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt"><span></span></p></td><td colspan="7" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:6pt; text-align:center"><span>(</span><span style="font-style:italic">Signature of authorized officer</span><span>)</span></p></td></tr><tr><td style="width:31.1%; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:23pt"><span></span></p></td><td colspan="2" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:23pt"><span></span></p></td><td colspan="7" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:23pt; text-align:center"><span>(Rank and appointment)</span></p></td></tr><tr style="height:0pt"><td style="width:132.6pt"></td><td style="width:23.8pt"></td><td style="width:74.1pt"></td><td style="width:60.4pt"></td><td style="width:18.35pt"></td><td style="width:37.1pt"></td><td style="width:7.95pt"></td><td style="width:15.85pt"></td><td style="width:15.8pt"></td><td style="width:40.5pt"></td></tr></tbody></table>