A guide for people applying for Family Violence Orders (FVOs)

What do I need to complete?

To make an application please complete the forms and lodge at the ACT Magistrates Court, Knowles Place, Canberra

An application for a family violence order (Form 1);

A private and confidential form to provide to the police. This will assist the police to locate the respondent
and serve your application and any orders made. This will not be provided to the respondent.
A notice of address for service (this will be kept confidential unless you consent to its release);
You may need to appoint someone to represent you, as a litigation guardian, if you are under 14 years of
age or have impaired decision making ability. If so, you will need to have that person complete a Statement
for appointment as a litigation guardian.

FOR MORE INFORMATION AND TO ACCESS FORMS: courts.act.gov.au/magistrates/protection

What is family violence?

It is behaviour by a person in relation to a family member
that may include:
a) Physical violence or abuse f) Coercion or any other behaviour that:
— Controls or dominates the family member; and
— Causes the family member to feel fear for the safety
c) Emotional or psychological
or wellbeing of the family member or another person;
abuse;
g) Behaviour that causes a child to hear, witness or
d) Economic abuse;
e) Threatening behaviour or the effects of the behaviour;

Without limiting any of the above, that behaviour may include:

A FAMILY MEMBER is a person is who is:

A person applying for a FVO is called ‘the applicant’. An applicant may also be an affected person, but the
police, a parent or litigation guardian may apply for a protection order for an affected person.
COMMON TERMS EXPLAINED

Who is an AFFECTED PERSON? Who is a RESPONDENT?

has been or is likely to be committed. or against whom a family violence order has been made.

Who is a PROTECTED PERSON? Who is a LITIGATION GUARDIAN?

a family violence order. impaired decision making ability.

OBTAINING A FVO AGAINST A CHILD OR YOUNG PERSON

It is not possible to obtain a FVO against a child aged under 10. If the respondent is aged 10–14, the
Court will usually require them to be represented by a parent, lawyer, or litigation guardian who can run
the case for them.

CONFIDENTIALITY OF YOUR ADDRESS

It is not necessary for the Court to tell the respondent your address in order to make a FVO. If you do not want
the respondent to know your address, do not put it on the application form. The Court will ask you to complete
a notice of address for service. This will be kept confidential unless you give the Court consent to disclose it.

If you would like legal advice about your situation or have trouble with these forms,
please call (02) 6207 1874 or drop in to the Legal Aid Protection Unit located in the
ACT Magistrates Court.
FORM 1: Application for a Family Violence Order (FVO)
Family Violence Act 2016

In the Magistrates Court of the Australian Capital Territory

(Court staff to complete)

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

Giving false or misleading information is a serious offence, punishable by a fine, imprisonment or both.

IMPORTANT:
it confidential from the other party. (See instruction form for further details.)

WHICH PEOPLE? Please include full names, dates of birth and any aliases

AFFECTED PERSON(S) person(s) for whom protection is sought (include any children)
All adults must complete a separate application unless a litigation guardian is appointed

Family name(s) Other name(s) Date of birth

APPLICANT (if you are not the affected person)

Family name(s)

Other name(s)

Are you a police officer? Yes No

If yes, does the affected person consent to the application? Yes No

Are you a parent of the affected person? Yes No

Are you a litigation guardian? Yes No

If yes, complete a Statement for appointment as a litigation guardian (available on the Court’s website)

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

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 RESPONDENT (name of person who the application is against)

Family name(s)

Other name(s)

RESPONDENT’S ADDRESS

Postcode

Relationship between affected

person(s) and respondent

Does the respondent know where the affected person(s) live? Yes No Unsure

Is an immediate (interim) protection order sought? Yes No

If YES, why?
— To ensure the safety of an affected person(s) from family violence? (short explanation)

— To prevent substantial damage to an affected person(s) property? (short explanation)

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

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 Are there any parenting orders or plans or current proceedings
under the Family Law Act involving the affected person(s) and Yes No Unsure
the respondent? (If YES, please ATTACH a copy)

If there are other, current court or tribunal orders about the affected person(s) or respondent that the
court should know about, provide details below.
Examples include care and protection orders, mental health orders, family or personal violence orders,
remand orders, detention orders or good behaviour orders.

HISTORY OF FAMILY VIOLENCE?

Has the respondent engaged in anything that is family

Yes No
violence towards any of the affected person(s)?
(see the definition of family violence at the front of this form)

What is the most recent incident of family violence by the respondent?

What happened? When did this occur? To which affected person?
(Attach extra pages if more space is needed)

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

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 Have you made any reports to the police about that behaviour? Yes No
If YES, police incident number:

Have the police charged the respondent with any criminal Yes No Unsure
offences for that behaviour?
If the respondent has been charged, list the charges (if known):

Do you or other affected persons fear that the respondent

Yes No
may engage in family violence?
If YES, explain why:

Is the respondent on bail? Yes No Unsure

If the respondent has bail conditions relating to the affected person(s), include details:

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

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 SAFETY AND HOUSING

Does the respondent own a gun(s) or have a gun licence? Yes No Unsure

Has the affected person(s) previously been granted a FVO or

similar protection order against the respondent anywhere in Yes No Unsure
Australia or New Zealand?

Is the Order current? Yes No Unsure

Include details or provide the Court with a copy if you have one:

Has the respondent breached any FVO? Yes No Unsure

Include details:

Are you seeking an order that will exclude the respondent

Yes No
from where they normally live?
If YES:
Yes No
Yes No

Yes No
somewhere else to live?
You
You:
need to find somewhere else to live?
Respondent:

If the respondent is a child, are you seeking an order excluding

Yes No
the child from where they normally receive care and protection?
If YES:
Yes No
Yes No

Yes No
somewhere else to live?
You
You:
need to find somewhere else to live?
Respondent:

— What alternative arrangements have been made for a child

respondent’s care (including their education) or safety?

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

5
 Do you want the Court to send a copy of any order made to any
Yes No
of the following?

If YES, include details:

School

Child care

Child and Youth Protection Services

Family Court/Federal Circuit Court Registry

LENGTH OF ORDER YOU ARE SEEKING

Period of final order

Length of order: months (for a period of up to 24 months)

If you require a longer order, for how long do you seek the order?

If you believe those circumstances do exist, please set them out here:

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

6
 WHAT ARE YOU ASKING THE COURT TO PROHIBIT THE RESPONDENT FROM DOING? Who to?

If you are asking for exceptions to these prohibitions, please tick any boxes below that Please
you want to apply, or write other exceptions in the spaces provided.
one or both

Adult Child
The respondent be prohibited from: affected affected
person person

1. Being where the affected person(s) live(s)

Include details: (Do not include if you want to keep this confidential)

EXCEPT on one occasion in police company to collect or return belongings;

EXCEPT in accordance with an order or a parenting plan made under the

Family Law Act 1975;

EXCEPT

2. Being on premises where the affected person(s) work(s)

Include details:

EXCEPT

3. Being on premises where an affected person(s) is/are likely to be (eg. your parents’ house)
Include details:

EXCEPT

4. Being in another particular place (eg. a school)

Include details:

EXCEPT at parent-teacher interviews and other school events for the

respondent’s children;

EXCEPT

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

7
 WHAT ARE YOU ASKING THE COURT TO PROHIBIT THE RESPONDENT FROM DOING? Who to?

If you are asking for exceptions to these prohibitions, please tick any boxes below that Please
you want to apply, or write other exceptions in the spaces provided.
one or both

Adult Child
The respondent be prohibited from: affected affected
person person

5. Being closer than a set distance (eg. 100 metres) from the affected person(s)
If yes, please say below how far away

metres

EXCEPT in accordance with orders or a parenting plan made under the

Family Law Act 1975, when the distance shall be metres;

EXCEPT in relation to the respondent’s children, when spending time with them
in accordance with orders or a parenting plan made under Family Law Act 1975;

EXCEPT at a counselling/mediation session or restorative justice conference

arranged with the consent of the affected person(s);

EXCEPT

6. Locating or attempting to locate an affected person(s)

EXCEPT

7. Contacting an affected person(s)

EXCEPT through a solicitor;

EXCEPT at a counselling/mediation session or restorative justice conference

arranged with the consent of the affected person(s);

EXCEPT in accordance with orders or a parenting plan made under the

Family Law Act 1975;

EXCEPT in writing (including by SMS or email) to discuss the safety or welfare

of the children or to facilitate contact handover of the children;

EXCEPT

8. Engaging in behaviour that constitutes family violence (see the definition of family
violence at the front of this form)

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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

8
 WHAT ARE YOU ASKING THE COURT TO PROHIBIT THE RESPONDENT FROM DOING? Who to?

If you are asking for exceptions to these prohibitions, please tick any boxes below that Please
you want to apply, or write other exceptions in the spaces provided.
one or both

Adult Child
The respondent be prohibited from: affected affected
person person

9. Causing someone else to locate or attempt to locate an affected person

10. Causing someone else to contact an affected person

11. Causing someone else to do anything that is family violence in relation to the
affected person(s)

12. Taking possession of the following personal property that the affected person(s) or
their child(ren) reasonably need(s):

WHAT ARE YOU ASKING THE COURT TO TELL THE RESPONDENT TO DO? To/about who?
Adult Child
affected affected
person person

1. Return particular personal property that the affected person(s) or their child(ren)
reasonably need(s).
Include details:

2. Participate in counselling, training, mediation, rehabilitation or assessment that is

reasonably likely to reduce the risks of future family violence by the respondent.

Approved form under Court Procedures Act 2004, s 8 Form number AF2017-198
If filed by a solicitor, name and address for service: ...............................................................................................................................................................................................

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