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Part 5 Safety - Response
Based on ‘Part 5 Safety’ or ‘Part 5 Urgency and Safety’ of the application that has been
served on you, check the boxes to show you have given these details below:
Which details provided under ‘supporting information’ that you agree with (include the line or paragraph
number of each statement from the original application).
Which details provided under ‘supporting information’ you do not agree with and why (include the line or
paragraph number of each statement from the original application).
Whether there are any other safety concerns that are not mentioned in the supporting information and
evidence. This includes if any party and/or household member (including partners of any party) who pose a risk
You must give specific
to the children(ren) or have violence, sexual and drug or alcohol related convictions.
detail of any safety concerns, risk and/or convictions and by whom.
[118] _______________________________________________________________________
[119] _______________________________________________________________________
[120] _______________________________________________________________________
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[132] _______________________________________________________________________
[133] _______________________________________________________________________
[134] _______________________________________________________________________
[135] _______________________________________________________________________
[136] _______________________________________________________________________
[137] _______________________________________________________________________
[138] _______________________________________________________________________
[139] _______________________________________________________________________
[140] _______________________________________________________________________
[141] _______________________________________________________________________
[142] _______________________________________________________________________
Exhibits referred to on this page (by assigned letter e.g. “A”):
Initials: