PAGE 1Guide to applying for a ProtectionOrder
GUIDE
V1 June 2019
Family Violence Act 2018
Guide to applying for a
ProtectionOrder
About this guide
Read this guide to find out more about applying for a Protection Order. If you want a Protection Order you will need to
fill out a Protection Order Application and Adavit. Take your time to complete this Application and speak to friends or
family/whānau if you need support.
What is a Protection Order?
A Protection Order is a court order made by a Judge. The Order says that the person you need protection from must stop
being violent, abusive or threatening towards you, your children or anyone else named in the Order.
Who can apply for a Protection Order?
Anyone who needs protection from someone who is violent, abusive or making threats can apply. You must have, or
previously had, a close personal relationship with that person. It could be a partner, ex partner, flatmate, carer or family/
whānau member. They don’t have to be living with you.
How will a Protection Order help keep you safe?
A Protection Order means the person you want protection from can be arrested if they hurt, threaten, approach or contact
you, your children or anyone else named in the Protection Order.
If a Judge makes a Protection Order, once the person you want protection from has been given
(served) the Order, they mustn’t:
1. Be violent, abuse or threaten you, your children or anyone else named in the Order. The violence, abuse or threats can be
physical, sexual, psychological or financial.
2. Encourage anyone else to be violent, abuse or threaten you, your children or anyone else named in the Order.
3. Damage or threaten to damage your property or harm your pets.
4. Make contact with you unless you’ve told them it’s OK in writing. You decide if the person you want protection from can
stay in your home with you and what contact you have with them, if any.
IMPORTANT NUMBERS – IF YOU’RE IN DANGER NOW – CALL 111
These organisations are here to support you, and help keep you and your family safe. These services are free.
Women’s Refuge:
Freephone:
0800 733 843
24 hours, everyday
www.womensrefuge.org.nz
Shine:
Freephone:
0508 744 633
9am-11pm everyday
www.2shine.org.nz
Shakti:
Freephone: 0800 742 584
Shakti is a support service for Asian,
African and Middle Eastern women
and their children – 24 hours, every day
shakti-international.org/shakti-nz/
PAGE 2Guide to applying for a ProtectionOrder
GUIDE
V1 June 2019 PAGE 2
What do these words mean?
The Protection Order form uses words and terms that may be new to you.
Term Description
Applicant The person who needs protection – this is usually the person who is filling out this form (you).
Respondent The person you’re asking for the Order against. This is the person that you want to be protected from.
Associated
Respondent(s)
A person (or people) who you also want protection from – they’re also being violent, abusive or
threatening towards you after being encouraged by the Respondent.
Served When a document (such as a Protection Order) is ocially given to the Respondent, for example by
Police or a Court Ocial.
Address for
Service
The respondent must send you a copy of their document if they choose to defend your application.
This is the address they will send the document to. Even if you want your home address to be
confidential, YOU must still provide an Address for Service.
Adavit This is when you write out in detail about why you need a Protection Order. This is your evidence.
The Adavit is a legal document and everything you write must be true and you have to get your
statement signed o by someone who has the legal authority to do so – such as a lawyer or a Justice
of the Peace (JP). The Respondent receives your Adavit when they’re served. For more information
refer to the Adavit guide.
Without
Notice
This means that the Respondent is not told about the application. They don’t get to talk to the Judge
about the application before the decision is made by the Judge. The Judge can also make a Temporary
Order for your protection while a decision is being made on the Protection Order application.
On-notice This means that the Respondent will be told that an application is being made for a Protection Order
against them. They will have an opportunity to talk to the Judge before a decision is made.
Special
conditions
This means other things you want the Judge to order, so that you and/or your children are kept safe.
It may also include exceptions to the Order about when, and how, the Respondent can contact you or
your children.
PAGE 3Guide to applying for a ProtectionOrder
GUIDE
V1 June 2019
Do you need legal advice?
You can make this application yourself or you may want to get a lawyer to help you fill out this form.
The New Zealand Law Society has a directory of lawyers around New Zealand.
Visit: www.lawsociety.org.nz
Legal aid: If you can’t aord a lawyer you may qualify for legal aid which will pay for a lawyer. You can
find out more about applying for legal aid here: https://www.justice.govt.nz/get-legal-aid
Community Law Centres have lawyers who can support you, and this service is usually free. To find your
closest Community Law Centre look in your phone book or online at www.communitylaw.org.nz
Do you have questions about this form?
If you have questions about this form you can call the Ministry of Justice on freephone:
0800 268 787 (9am – 5pm, Monday – Friday)
What is violence?
Violence can be many things including:
Physical Someone hurting you. For example by hitting, slapping, kicking you with their body, a weapon or an
object, strangling, choking, suocating, or burning you.
Sexual Someone pressuring you to do something you don’t want to do sexually. For example someone
forcing you to have sex, touching you or forcing you to perform sexual acts or watch pornography.
Emotional and
psychological
For example someone putting you down, making you feel useless, calling you names, humiliating you
in private or in public. Someone controlling you, isolating you, stopping access to aids or medication,
being cruel to your pets, stalking or harassing you in person or on your phone or on the internet,
breaking your things, or breaking into your home.
Financial For example someone taking money from you, using your bank cards, getting you into debt without
your permission. Someone pressuring you to get a loan or to sell your property. Stopping you from
accessing your money.
Threats and
intimidation
Someone making threats to you face-to-face, over the phone, by email or written in notes, letters or
on social media.
Examples of a threat can be:
Someone saying they’re going to hurt or kill you, your children, or a pet.
Someone holding their fist, a knife, hammer, gun or other weapon near you and threatening to
hurt you (but not physically hurting you).
Someone threatening to report you to authorities (for example Immigration, Work and Income,
Oranga Tamariki)
Someone saying they’re going to commit suicide to try and control what you do.
PAGE 4Guide to applying for a ProtectionOrder
GUIDE
V1 June 2019
Do you want to apply for a Protection Order?
You will need to complete a Protection Order Application, an Adavit and Information for Police Form.
You can get these from your local Court or online at https://www.justice.govt.nz/family/family-violence/protection-
order-forms/
Do you need other Orders?
Occupation, Tenancy and Furniture Orders
You can ask the Judge to make decisions about your living arrangements and furniture by filling in an
application for a Property Order. This includes Occupation, Tenancy or Furniture Orders. You can apply
for these Orders at a later time once you have a Protection Order.
If you want to live in the dwelling (house, apartment or other), fill in either:
1. Application for an Occupation Order – if you, the respondent (or both) own or part own the dwelling
2. Application for a Tenancy Order – if you’re renting the dwelling
If you’re asking for either an Occupation or Tenancy Order and want to keep some or all of the furniture,
you can also fill in an Application for an Ancillary Furniture Order.
OR
If you’re moving out and want some or all of the furniture, you can fill out an Application for a
FurnitureOrder.
When you’ve finished your form
When you’ve finished your form, you’ll need to take it to the nearest Court.
You’ll need to swear or arm your facts are true. This means a Deputy Registrar at a Court, a Lawyer or a
Justice of the Peace will watch (witness) you signing the Adavit form and take your oath.
Free Safety Programmes are available for you and your children.
If you’re granted a Protection Order, you’ll be oered a free Safety Programme. You don’t have to go,
but it can be really helpful to get some support and work out the next steps. Free Safety Programmes
are also available for your children, to help them make sense of what’s happening. Someone from the
Court will contact you and ask if you or your children would like a programme and will give you all the
information you need.
You or your children can also ask the Court for information about these safety programmes while the
Protection Order is in place.
PAGE 1
Application for a Protection Order
Family Violence Act 2018
Section 60, Family Violence Act 2018
Application for a Protection Order
APPLICATION
V1 June 2019
Important:
Do you want your address to be kept confidential from the Respondent? 
Yes
No
If yes don’t fill in your address anywhere on this form. You will also need to complete the Request for
Confidentiality Form.
This application is
Without notice
On-notice See page 2 of the Guide to applying for a Protection Order.
Applicant (you, or the person who needs protection)
Full name
Home
Address
Respondent (the person you’re saying you need protection from)
Full name
Home
Address
Occupation
Associated Respondent (fill this in if there are other people that you’re saying you need protection from.
See page 2 of the Guide to applying for a Protection Order.)
Full name
Home
Address
Occupation
In the Family Court at (Court location) FAM
COURT USE ONLY:
Date document is filed: (Court stamp)
PAGE 2Application for a Protection Order
APPLICATION
V1 June 2019
I (your name)
am applying for a Protection Order against (Respondent’s/Associated Respondent’s name)
This document is filed by:
Name
Address for service
Note: Even if you want your home address to be confidential, YOU must still provide an Address for Service.
If filed by lawyers:
Name of acting lawyer
Contact number
PAGE 3Application for a Protection Order
APPLICATION
V1 June 2019
Applicant
Full name
Date of birth
D D M M Y Y Y Y
Age
Gender 
Ethnicity
Country where you usually live 
Do you need an interpreter?
Yes
No
Language
Occupation
Don’t fill in the following contact information if you have ticked yes for a confidential address on the
previous page.
Home address
Work address
Email address
Phone number
What is the best way to contact you?
Address for service. This is where any written information will be sent to you. See page 2 of the Guide to
applying for a Protection Order.
PAGE 4Application for a Protection Order
APPLICATION
V1 June 2019
Children’s* details
Who else is this Protection Order for?
A Protection Order automatically covers you, your children who usually live with you (part time or full time) and
any child born after the date any Order is made. Please fill out their details below.
Child 1
Full name of child 
Date of birth
D D M M Y Y Y Y
Your relationship to child 
Respondents relationship to child 
Who is the child currently living with and what is that person’s relationship to the child?
Child 2
Full name of child 
Date of birth
D D M M Y Y Y Y
Your relationship to child 
Respondents relationship to child 
Who is the child currently living with and what is that person’s relationship to the child?
Child 3
Full name of child 
Date of birth
D D M M Y Y Y Y
Your relationship to child 
Respondents relationship to child 
Who is the child currently living with and what is that person’s relationship to the child?
Child 4
Full name of child 
Date of birth
D D M M Y Y Y Y
Your relationship to child 
Respondents relationship to child 
Who is the child currently living with and what is that person’s relationship to the child?
If you have more than four children please use another piece of paper and include the same information for
eachchild.
* NOTE: A child means a person who is under the age of 18 years (s8 Family Violence Act).
PAGE 5Application for a Protection Order
APPLICATION
V1 June 2019
Are there any current orders relating to any of those children?
(for example, Parenting Orders or Oranga Tamariki Orders).
Yes
No 
Don’t know
Please give details if you know any of the following (it’s OK if you don’t know):
File number
What they were for
Who they involved
Date they were made
D D M M Y Y Y Y
Court they were made to
PAGE 6Application for a Protection Order
APPLICATION
V1 June 2019
Other people who need protection
A Protection Order can also cover other people you’re close to if it’s necessary for
theirprotection.
Does this Order need to cover anybody else? This might be a family member, your current spouse/partner,
adult children (18 years old and over), another person in your household or someone else you may have a close
personal relationship with.
Their full name
What is their
relationship
to you?
Do they agree with
you adding them to
this order?
Yes
Yes
Yes
Yes
Yes
Yes
Anyone named here should (if possible) agree in writing to be covered by the Protection Order.
If there is no practical way to get their consent, you must say why in your Adavit.
Note:
Someone can only be covered by your Protection Order if they need to be protected because of the
relationship the Respondent has with you.
Make sure the reason why they need to be included is explained in the adavit (page 5 of the Adavit form).
Special conditions
Do you have any conditions you want the Judge to include on the Order? For example, this may include times
when the Respondent may need to make contact with you or any of the protected people.
PAGE 7Application for a Protection Order
APPLICATION
V1 June 2019
The Respondent
Please complete if known
Full name
Date of birth
D D M M Y Y Y Y
Age
Gender 
Ethnicity
Country where they usually live 
Home address
Work address
Email address
Phone number
Is the Respondent a member of either the Police or Armed Forces? 
Yes
No
If yes, which one? 
Police 
Army 
Navy 
Air Force
Location
PAGE 8Application for a Protection Order
APPLICATION
V1 June 2019
Other information
Have you or the Respondent ever submitted other applications against each other to the
Family Court?
Yes
No 
Don’t know
Please give details if you know any of the following (it’s OK if you don’t know):
File number
What they were for
Who they involved
Date they were made
D D M M Y Y Y Y
Court they were made to
Adavit in support
I rely on the content of the adavit dated
D D M M Y Y Y Y
filed in support of this
application (or these applications).
Signature
Signed
Date
D D M M Y Y Y Y
PAGE 1Guide to completing your Adavit
GUIDE
V1 June 2019
What is an Adavit?
An Adavit is how you describe for the Judge what violence, abuse and/or threats the Respondent has used against you.
It’s your chance to tell the Judge your story.
It’s important that you include all the facts you can – such as:
when and where the violence happened
what actually happened
if anyone else was present (especially your children).
Everything you say must be true and correct and you should only include facts that are relevant to why you need a
Protection Order.
This information can help the Judge understand the situation and decide whether to grant the Protection Order
and if it’s needed without notice. You must write or print your adavit on one side of the paper only.
Tip:
It can be helpful to use bullet points to set out the facts. This means, listing the facts. Keep the
information clear and simple so it’s easy for the Judge to understand what happened and how it
made you feel.
The Adavit will ask you to write about what has been happening, including:
The most recent incident of violence that led you to making the Protection Order application
If the application is made without notice, how a delay in making the Protection Order could put you (and/or your children)
in danger
The violence that has happened in the past
How the violence has made you feel and its impact on you, your children and anyone else named in the application
If you’re including “Special Conditions”, detail why these are important to you and/or your child(ren).
Family Violence Act 2018
Guide to completing your
Adavit for your Protection Order
About this guide
Read this guide to find out more about completing your Adavit. Take your time to complete this document and speak
to friends or family/whānau if you need support.
PAGE 2Guide to completing your Adavit
GUIDE
V1 June 2019
Documents to support your Adavit
You can attach documents to support your Adavit. For example a doctor’s or dentist report, police reports, screenshot of
abusive texts etc. These are called “Exhibits” and you should name them in the order you write about in your Adavit. For
example, if the first document you write about in your Adavit is a doctors report, write “EXHIBIT A” on the top of the copy
of the doctors report. Then you write (see Exhibit A) in your Adavit. Your next document will be “Exhibit B” and so on.
A
EXHIBIT A
EXHIBIT B
EXHIBIT C
B
C
“Exhibits”
are helpful but
not necessary
If you’ve had any family violence incidences reported to the Police you can request for these reports to be given to you and
attach them to the Adavit as Exhibits. However, you don’t have to have these.
To get these Police report(s) you’ll need to fill in a request form (https://forms.police.govt.nz/privacyactrequest). Make
sure you ask for it to be handled urgently for a Protection Order application.
This is a legal document:
Everything you say must be true and correct to the best of your knowledge and belief
It should only contain details about your situation. Try to include specific names, dates, and places if
you have them
It must say why you need a Protection Order and if its urgent, and your reasons why its urgent.
You need to initial the bottom of each page and sign the final page in front of a Deputy Registrar of
the Court, a Lawyer or a Justice of the Peace
With your signature, you’ll be confirming that everything you have said is true.
It’s best to prepare
Before you write your Adavit, it may help to take some time to think about what has happened. Dates can be hard to
remember but are important in the Adavit, so think about anything that can help you remember about the times when
things happened.
Remember violence is NOT only about physical harm. Family violence can also be:
intimidation and threats
emotional and psychological abuse
sexual violence and/or financial abuse
physical violence.
Family violence can be a build-up of lots of little things that mean you’re now feeling frightened. To help you remember what
this could be, we have included some check lists of the dierent forms violence can take.
PAGE 3Guide to completing your Adavit
GUIDE
V1 June 2019
Psychological Abuse
Humiliated you alone or in public
Put you down, called you names
Stalked, constantly harassed or texted you
Controlled your access to money
Tried to make you think you’re going crazy
Controlled what you do or who you talk to
Ridiculed your religious or spiritual beliefs or
values
Prevented you from phoning or visiting family
and/or friends
Threatened to harm or kill themselves if
youleave
Intimidation and Threats
Threatened to kill you
Threatened you with a weapon
Screamed or yelled at you
Punched walls or doors
Threatened to hurt or kill your children
Would not leave your home when asked
Threatened to report you (eg to Immigration,
Work and Income, Oranga Tamariki)
Threatened to hurt or kill your pets
Physical Violence
Ever used physical violence against you
Choked, strangled or suocated you
(or tried to)
Slapped, hit, punched or kicked you
Pushed, grabbed, tripped, shoved you
Held you down against your will
Shook or thrown you to the ground
Used a knife, gun or other weapon
againstyou
Sexual Violence
Physically forced you to have sex
Forced you to perform sexual acts
Pressured you to have sex using threats
Forced you to watch pornography (porn)
Forced you to have sex in a way you didn’t
want to
Had sex with you while you were asleep or
unconscious
Are there any other examples you could include in your Adavit?
Tip:
When you write your adavit, remember to include any details you can about when and where and how
often this violence happened.
Use the checklist on this page to help you remember what’s happened
The checklist has some examples of the dierent forms of family violence. These are not the only examples of Family
Violence but may help you think about your experiences and remember what has happened.
Has the Respondent done any of these things:
Tick each of those that apply to you
PAGE 1
Adavit
Family Violence Act 2018
In support of applications for a Protection Order.
Adavit
AFFIDAVIT
V1 June 2019
Applicant (you, or the person who needs protection)
Full name
Home
Address
Occupation
Respondent (the person you’re saying you need protection from)
Full name
Home
Address
Occupation
Associated Respondent (fill this in if there are other people that you’re saying you need protection from.
See page 2 of the Guide to applying for a Protection Order.)
Full name
Home
Address
Occupation
In the Family Court at (Court location) FAM
Note:
The applicant’s address may be omitted from the front page where the applicant has asked for this information
to be kept confidential.
COURT USE ONLY:
Date document is filed: (Court stamp)
PAGE 2Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
I, (Full name)
of, (Address)
(Write address unless you want to keep it confidential from the Respondent)
Occupation
swear/solemnly and sincerely arm that:
My relationship to the Respondent is
Spouse/partner 
Family/whānau member 
We have a close personal relationship
We live in the same home 
Ex spouse/partner
Give details about your relationship, such as:
Date and place of marriage or civil union
Whether you’re still together or separated
If not a partner, their relationship to you
How long you have known them for
Whether you live in the same house
How long you have been in a relationship with the person
The Respondent has
Drug and/or alcohol issues 
Yes
No  Mental health issues 
Yes
No
If yes, please describe what these are (if you can)
The Respondent has had Protection Orders issued against them by someone else in the past
Yes
No 
Don’t know
If yes, please provide details of those orders (if you can)
PAGE 3Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
Please describe the most recent incident of violence, including
Date, time, and place
What was said and done (all forms of violence. Refer to page 3 of the Guide to completing your Adavit)
If anyone else was present and saw what happened (witnessed)
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
PAGE 4Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
Please describe the history of violence including:
Date, time and place
What was said and done (all forms of violence)
If anyone else was present and saw what happened (witnessed)
If you have children, have they witnessed any of the violence that you have described?
Yes
No 
If yes, please give details.
PAGE 5Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
Note:
If you don’t have any information to add into one or more of these boxes, it’s ok to leave that box blank.
How has this violence, abuse or threats aected you and/or your children?
How did this make you feel?
Have there been any Police callouts or has the Respondent had a Police Safety Order
issued against them in the past?
Yes
No 
Don’t know
If yes, please provide details such as date and what happened (if you can)
Does the Respondent have any convictions for violence against you, your family or
anyone else?
Yes
No 
Don’t know
If yes, please provide details such as date and what happened (if you can)
PAGE 6Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
If you’re making this application without notice, please describe why you fear for your
immediate safety and how a delay in getting the Protection Order might put you or your
children in any danger.
If you have asked for “Special Conditions, please describe the reasons for these.
If you have named anyone else that needs protection (other than your children living with
you) please explain why and what has happened to them.
PAGE 7Adavit
AFFIDAVIT
V1 June 2019
Exhibits referred to on this page (by assigned letter e.g. “A”) Initials:
Tell us why you also need to be protected from other Associated Respondents?
For example, how is the Respondent encouraging/has encouraged the Associated Respondent to take violent
or threatening action against you (or your children)? What action has the Associated Respondent taken against
you (or your children)?
Signature
Signed
Sworn or Armed at (place)
on this (date)
D D M M Y Y Y Y
Before me
(Signature of Registrar/Deputy Registrar, or Justice of the Peace or a solicitor of the High Court of New Zealand)
Important:
You need to complete this page and sign in front of either a Registrar/Deputy Registrar, or Justice of the
Peace or a solicitor of the High Court of New Zealand. That person is your witness. Once it’s signed by the
witness, you then hand the application, adavit and any other documents in at your nearest Court.
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