Fillable FORM 7: PROTECTION ORDER 24 [Regulation 8(b)] SECTION (South Africa Department of Justice and Constitutional Development)

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FORM 7: PROTECTION ORDER 24 [Regulation 8(b)] SECTION (South Africa Department of Justice and Constitutional Development)

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Department of Justice and Constitutional Development
24
FORM 7
[Regulation 8(b)]
PROTECTION ORDER
SECTION 6 OF THE DOMESTIC VIOLENCE ACT, 1998 (ACT NO. 116 OF 1998)
(This form must be completed if an interim protection order was not issued).
IN THE MAGISTRATE’S COURT FOR THE DISTRICT OF ____________________
HELD AT ___________________ APPLICATION NO._______/_____
In the matter between:
APPLICANT: ______________________________________________________
(*Id.No./Date of Birth:_________________________________)
AND
RESPONDENT: ____________________________________________________
(*Id.No./Date of Birth:_________________________________)
1. PARTICULARS OF RESPONDENT
Home Address: ______________________________________________
______________________________________________
______________________(Tel.No._______________)
Work Address: ______________________________________________
______________________________________________
________________________(Tel.No._______________),
Occupation:______________________________________________________
2. PARTICULARS OF APPLICATION
Whereas the Applicant has applied for a Protection Order against the
Respondent as per the affidavit(s) and record of oral evidence(if any) attached,
and an interim protection order was not issued, and after consideration of the
application the Court now makes the order hereunder.
3. ORDER BY COURT
3.1 The Court orders that :
3.1.1 *The application for a Protection Order is dismissed; or
3.1.2 *An Interim Protection Order is granted; and the Respondent is ordered-
3.1.2.1 *not to commit the following act(s) of domestic violence _______________
REPUBLIC OF SOUTH AFRICA
J566E
Department of Justice and Constitutional Development
25
________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________________________________;
3.1.2.2 *not to enlist the help of another person to commit the acts of domestic
violence specified in paragraph 3.1.3;
3.1.2.3 *not to enter the shared residence at_____________________________
_______________________________________________________________
3.1.2.4 *not to enter the following parts of the shared residence ______________
___________________________________________________________
at_________________________________________________________
__________________________________________________________;
3.1.2.5 *not to enter the Complainant’s residence at ______________________
__________________________________________________________;
3.1.2.6 *not to enter the Complainant’s place of employment at _______________
__________________________________________________________;
3.1.2.7 *not to prevent the Complainant or any child who ordinarily live(s) or lived
in the shared residence at__________________________________________
from entering or remaining in the shared residence, or any part thereof;
3.1.2.8 *not to commit any of the following acts, to wit____________________
____________________________________________________________
____________________________________________________________
__________________________________________________________;
3.1.2.9 *to make rent or mortgage payments in the sum of R____________ per
month / annum;
3.1.2.10 *to pay the sum of R____________ to the Complainant as emergency
monetary relief.
4. ADDITIONAL ORDERS
4.1 It is further ordered that :
4.1.1 *A peace officer, namely, ............................................... accompanies the
Applicant to the following residence in order to assist with arrangements
regarding the collection of personal property, i.e_____________________.
_____________________________________________________________
____________________________________________________________
___________________________________________________________;
4.1.2 *A member of the South African Police Service at ____________________
seizes the following arm(s) or dangerous weapon(s) in the possession of the
2
J566E
Department of Justice and Constitutional Development
26
Respondent, i.e.________________________________________________
____________________________________________________________
___________________________________________________________;
4.1.3 *The Complainant’s physical address not be disclosed to the Respondent;
4.1.4 *The Respondent is ordered not to have any contact with the following
child(ren)_____________________________________________________
__________________________________________________________
__________________________________________________________
_________________________________________________________;
4.1.5 *The Respondent is allowed contact with the following child(ren)_________
____________________________________________________________
____________________________________________________________
___________________________________________________________,
on the following basis:___________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
__________________________________________________________;
4.1.6 *The Respondent _____________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________;
4.2 A Warrant is authorised for the arrest of the Respondent, the execution of
which is suspended subject to the Respondent’s compliance with the
provisions of the Protection Order as stated above.
4.3 A copy of this order and the warrant of arrest must be forwarded to the
____________________________ Police Station, once this order has been
served on the Respondent.
__________________________ _________________
MAGISTRATE DATE
_______________________________________________________________
*Delete whichever is not applicable
J566E
3
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FORM 7: PROTECTION ORDER 24 Regulation 8(b) SECTION (South Africa Department of Justice and Constitutional Development)

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Completed 21 June 2021

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