Petition Sample
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1SAMPLE PETITION
This form is designed to help you prepare the front page of a petition. Subsequent pages
need to include only the ‘request’ of the petition, with names and signatures below it.
For more information contact the Petitions Committee
petitions.committee.reps@aph.gov.au or by phone (02) 6277 2152
ADDRESS
TO THE HONOURABLE THE SPEAKER AND MEMBERS OF
Petitions must be
addressed to the
THE HOUSE OF REPRESENTATIVES
House of Representatives
Here insert words describing
This petition of …
who the petition is from, e.g.
‘Certain citizens of Australia’
draws to the attention of the House:
REASON
This must be a matter on
which the House has power
to act - a Commonwealth
legislative or administrative
We therefore ask the House to:
matter
REQUEST
Note: the address, reason
and the request together
comprise the ‘terms’ of the
PRINCIPAL PETITIONER
petition and together must
not exceed 250 words
Name:
Signature:
____________________________________________
___________________________________________
Address:
_______________________________________________________________________________________________________
CONTACT DETAILS for
Postcode:
PRINCIPAL PETITIONER
__________________________________________________________________________________
__________________
This information is only
for the use of the Petitions
Email (if available):
Telephone:
________________________________________
_______________________________
Committee. It will not be
published
NAME AND SIGNATURE
1.
SIGNATURES OF
2.
OTHER PETITIONERS
• If required, attach
3.
additional pages for
signatures
4.
• The request must
appear at the top of
5.
each additional page
• Other information such
6.
as postal addresses
may also be provided
7.
• Signatures on the
reverse of a petition,
8.
or on a blank page,
will not be counted
9.
10.
11.
12.
13.
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Parent category: Legal