Affidavit For Uncontested Trial Page 4

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Form 23C:
Affidavit for Uncontested Trial
(page 4)
Court File Number
RESTRAINING ORDER
Fill out this section if you are claiming a restraining order against the respondent.
12. I need an order to restrain the respondent
(full legal name of person restrained)
(date of birth of person restrained)
from
a) contacting or communicating directly or indirectly with the following people
(full legal name and date(s) of birth of person[s]
protected by this order)
Name
Birthdate
(d, m, y)
except through
(name of person or agency)
to arrange access to the child(ren).
except to permit access to the child(ren)
(names and birthdates)
on
(dates/days and times)
.
except through or in the presence of counsel.
except through or in the presence of counsel or a clinical investigator from the Office of the Children’s Lawyer, if the
Children’s Lawyer is appointed to represent the child(ren).
b) coming within
metres
yards
feet of
(locations and addresses)
at any time or for any purpose
except under the following conditions:
(provide details of conditions, including time(s), purpose(s) of exception(s) and
address(es) as applicable)
c)
(any additional terms)
I need a restraining order for the following reasons:
FLR-23C-E (2009/09)
Page 4 of 5

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