Additional Resouces

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MY SAFETY PLAN

STEP ONE

Think about:

• Where you can go to make a telephone call;
• A safe place where you can go to stay in an emergency. This may be with a friend or
  relative, a women's refuge, a hotel or a B&B;
• The telephone number of the safe place;
• How to get to the safe place. Decide how you will get to the safe place at different times
  of the day or night;
• The number of a local taxi firm;
• What to tell the children, and how to tell it to them, when you need to put the safety
  plan into action;
• If you can, discuss your safety plan with a trusted friend so that they can support you if
  you need to put it into action.

STEP TWO

Important telephone numbers

24 HOUR Support Service 365 DAYS A YEAR

Women's Refuge……………………………………053 9121876 / 1800-220-444

Doctor ………………………………………………

Garda Station………………………………………

Taxi …………………………………………………

Law Centre / Solicitor…………………………….053 9122622

District Court……………………………………..053 9122097

Health Centre (CWO)…………………………….051 421445

Social Welfare Office…………………………….053 9123233

Housing Department………….. 087 8102590………….Wexford/Enniscorthy – 087 2839226

Rape Crisis Centre……………………………053 9122722

Family / Friends……………………………….

Others………………………………………….

STEP THREE

Collect together some important documents you may need and hide them in a safe place, such as a mobile phone, marriage & birth certificates, medical cards, PPS number, saving/bank details

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APPLICANT DETAILS

Name
Address

Phone number

DOB

Relationship to Respondent
Dependent children yes or no

RESPONDENT DETAILS
Name

Address
Phone number
DOB
Relationship to Applicant
Do you wish the respondent be prohibited from contacting you (including electronically)?
Yes No

INTERIM ORDER SOUGHT CRITERA Please tick one

Protection

PROTECTION ORDER

-Spouses / former spouses

-Civil partners / former civil partners

-Cohabiting couple / former cohabiting couples

-Couple / former couple

-Parent of child over 18

-Parents of children in common

-Living together in a non-contractual capacity

Interim Barring

-Spouses / former spouses

-Civil partners / former civil partners

-Couple cohabiting (applicant must have at least 50% interest in the family home)

- Parent of child over 18 (applicant must have at least 50% interest in the family home

Emergency Barring

- Unmarried couple cohabiting (applicant MUST have NO interest or less than 50% interest in the family home).

-Parent of a child over 18 (applicant MUST have NO interest or less than 50% interest in the family home

*For full information on eligibility criteria please refer to the information sheet.

I request (please tick one) an interim barring / protection order / emergency barring order against the respondent on the grounds that I am

1. the spouse of the respondent,
2. the civil partner (within the meaning of the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010) of the respondent ,
3. not the spouse or civil partner of the respondent and is not related to the respondent within the prohibited degrees of relationship, but lived with the respondent in an intimate and committed relationship prior to this application,
4. a parent of the respondent and the respondent is a person of full age who is not, in relation to the parent, dependent person,
5. of full age and residing with the respondent in a relationship which is not primarily contractual,
6. j) a person who was a party to a civil partnership with the respondent that has been dissolved under the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010
7. a parent of a child whose other parent is the respondent
8. not the spouse or civil partner of the respondent and is not related to the respondent within the prohibited degrees of relationship, but was in an intimate relationship with the respondent prior to this application

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