PEACE BOND STATEMENT OF COMPLAINT
(To be completed by person applying for a Peace Bond)
This form does not go before the Judge. A copy of this form will be given, if requested, to the
Defendant (the person you are seeking the Peace Bond against) or their lawyer for disclosure
purposes. It may be given to Victim Services or similar organizations and, in some cases, may
be used by Court staff to assist them understanding and processing your application.
Your full name:
Name of person you want to be placed on a Peace Bond:
Full name:
Address:
Date of Birth (month/day/year):
(telephone numbers) (e-mail address)
What event happened that caused you to apply for a Peace Bond?
What was the date(s) of this event? (month/day/year ):
Did you contact the police? Yes No
If yes, what instructions did you receive from the police?
If you did not contact the police, please give reason why?
List of names of Witnesses:
Your Signature Date (month/day/year)
