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2. PARTICULARS OF PROTECTION ORDER
A protection order was granted and a
warrant of arrest authorised on :
(Date)
In the Magistrate`s Court at :
Against :
(Name of Respondent)
3. PARTICULARS OF RESPONDENT
Surname :
Full names :
Id.No / Date of birth
Home address :
Home telephone number :
Work address :
Work telephone number :
4. PARTICULARS OF APPLICATION
4.1 I require a *second/further warrant of arrest for my protection.
4.2. The existing warrant of arrest has been -
(a) *executed and cancelled; or
(b)*lost
/
destroyed,
under
the
following
circumstances:
____________________________________________________________
____________________________________________________________
___________________________________________________________ .
_________________________
______________
Signature of Deponent
Date
__________________________________________________________________
*Delete whichever is not applicable
PART B : CERTIFICATION (for official use)
Department of Justice and Constitutional Development

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