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APPLICATION TO CANCEL / RESPONSIBLE UNDERTAKING ACT 1982 Form 14

1. Applicant Details Name Tick [ ] appropriate box

Police Officer/ Address Surety / Responsible Person Other Telephone No Fax

2. Accused Details Full Name Address

Date of Birth Male Female

3. Ref No/s

4. Accused Next Court Date Location

APPLICATION DETAILS

The accused is not likely to comply with the requirement of his/her bail undertaking; or Is or has been in breach of any condition of his/her bail undertaking; or

Other (please state reason)

Brief details of application

Signature of Applicant Date

APPLICATION HEARING DATE

Date Time or as soon after as possible

Place

DECISION OF COURT

Pursuant to Section 48(3) accused hereby caused to appear before the court by issue of Warrant to

Summons to attend; or

Application dismissed; or

Application adjourned to ……………/……………/…………

Judicial Officer…………………………………………………….Date…………/………………../……………

Important : Your obligation as a surety does not cease by submitting this application. Until the accused is brought before the Court and an order is made cancelling your surety undertaking, your obligations continue and an order for forfeiture may still be made if the accused fails to appear as required.

COURT COPY

APPLICATION TO CANCEL SURETY / RESPONSIBLE PERSON UNDERTAKING BAIL ACT 1982 Form 14

1. Applicant Details Name Tick [ ] appropriate box

Police Officer/Prosecutor Address Surety / Responsible Person Other Telephone No Fax

2. Accused Details Full Name Address Date of Birth Male Female

3. Court Ref No/s

4. Accused Next Court Date Location

APPLICATION DETAILS

The accused is not likely to comply with the requirement of his/her bail undertaking; or Is or has been in breach of any condition of his/her bail undertaking; or

Other (please state reason)

Brief details of application

Signature of Applicant Date

APPLICATION HEARING DATE

Date Time or as soon after as possible

Place

Important : Your obligation as a surety does not cease by submitting this application. Until the accused is brought before the Court and an order is made cancelling your surety undertaking, your obligations continue and an order for forfeiture may still be made if the accused fails to appear as required.

SURETY COPY

APPLICATION TO CANCEL SURETY / RESPONSIBLE PERSON UNDERTAKING BAIL ACT 1982 Form 14

1. Applicant Details Name Tick [ ] appropriate box

Police Officer/Prosecutor Address Surety / Responsible Person Other Telephone No Fax

2. Accused Details Full Name Address Date of Birth Male Female

3. Court Ref No/s

4. Accused Next Court Date Location

APPLICATION DETAILS

The accused is not likely to comply with the requirement of his/her bail undertaking; or Is or has been in breach of any condition of his/her bail undertaking; or

Other (please state reason)

Brief details of application

Signature of Applicant Date

APPLICATION HEARING DATE

Date Time or as soon after as possible

Place

Important : Your obligation as a surety does not cease by submitting this application. Until the accused is brought before the Court and an order is made cancelling your surety undertaking, your obligations continue and an order for forfeiture may still be made if the accused fails to appear as required.

POLICE/PROSECUTION COPY