1. Deposed on behalf of the Applicant
2. Applicant’s Name
3. No. of Statement:
4. Exhibits:
5. Dated:
6. Filed:
IN THE FAMILY COURT SITTING AT
Case No.
IN THE MATTER OF THE FAMILY LAW ACT 1996
B E T W E E N :-
Applicant Name
APPLICANT
-and-
Respondent name
RESPONDENT
___________________________________
STATEMENT OF Applicant Name
___________________________________
I, Applicant Name, currently a unemployed of address, will say as follows:
1. I make this statement in support of my application for a non molestation order. Save where
the contrary is stated, the facts in this statement are within my knowledge and are true and
made in the knowledge that this statement will be placed before the court as evidence in these
proceedings.
Background information
2. The respondent, name of address is an associated person to me under section 62(3) of the
Family Law Act 1996 because we used to be in an intimate relationship of significant duration
(confirm length of relationship and change reason of associate as suits the applicant’s
situation). The respondent does/does not live with me but he would stay over at my property
a lot, until our relationship came to an end on (confirm date if relevant or delete/ amend f this
does not apply).
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