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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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