NSW Domestic Violence Disclosure Scheme Application for someone I am concerned about to receive information What is the Domestic Violence How does the Scheme work? Take care when completing this Disclosure Scheme? You will need to complete this application as it is an offence The NSW Domestic Violence application form and submit it to a to provide false or misleading Disclosure Scheme helps people police station in a participating local information in an application, and who may be at risk of domestic area command where the person penalties apply. violence to find out if their current at risk lives. Police will review this What information will be or former partner has a history of application and do a criminal record disclosed? violent criminal offences. check on the current or former partner. A conviction will be disclosed to the How can the Scheme help prevent person who may be at risk where Even where the application is domestic violence? the subject of the application (i.e. made by a third party, the the current or former partner) has Domestic violence is usually disclosure is made to the person a relevant offence in their criminal characterised by a pattern of who may be at risk, unless there history. abusive and controlling behaviours, are exceptional circumstances and perpetrators often repeat determined by police. Relevant convictions are for these behaviours in successive personal violence offences You may be present at the relationships. The pilot Scheme committed within a domestic disclosure only where the person aims to prevent domestic violence relationship. These include: who may be at risk invites you to be from occurring by empowering there as a support person. those who may be at risk to make • Most personal violence offences such as murder, manslaughter, informed decisions about their Will their current/former partner physical and sexual assault, relationship. know that an application or a property damage disclosure was made? Where is the Scheme available? • Stalking and intimidation To ensure the safety of those who The Scheme is being piloted in may be at risk, the subject of the • Breaches of an Apprehended four NSW Police Force Local Area application (i.e. a current or former Domestic Violence Order. Commands: partner) will not be informed of Other relevant convictions include • Oxley (Tamworth region) any application or disclosure made certain personal violence offences • Shoalhaven (Nowra region) about them. committed outside of a domestic relationship: • Sutherland Can I make an application? (Menai/Engadine/Sutherland As a third party you must be • Sexual offences region) a family member, friend or a • Child abuse offences • St George professional who has an ongoing • Murder (Kogarah/Hurstville region) relationship with the person who may be at risk. To apply, you and the person who If a relevant conviction exists, the may be at risk need to be aged To apply, you and the person who person you are applying for will be 16 years and over. The person may be at risk need to be aged told the type of offence and the you are applying for must live in a 16 years and over. The person date of the conviction. The police participating local area command. you are applying for must live in a may also consider telling them A list of relevant suburbs and participating local area command. additional information, such as the postcodes is provided on page 7. You will need to complete and relationship between their current submit this application form at a or former partner and the victim of police station in the pilot region the offence. This will be considered where the person who may be at on a case-by-case basis because risk lives. police must be careful not to identify those victims. NSW Domestic Violence Disclosure Scheme · PAGE 1 Some offences and orders will not What support services will be What is an intimate relationship? be disclosed under the Scheme. available to the person I am For the purpose of the Scheme, These include: applying for? an intimate relationship includes A worker from a specialist domestic people who are married or engaged • Offences committed outside violence support service will be to be married, separated, divorced, NSW present at the disclosure to provide de facto partners, couples promised • Offences where no conviction support and help plan for their to each other under cultural or was recorded safety. religious tradition, or who are • Convictions that have become The support service may also dating. It may or may not involve spent arrange other help such as a sexual relationship and may be • Juvenile convictions translation services, trauma between people of the same or • Apprehended Domestic Violence counselling and other specialist different sex. Orders (these civil orders are not support as required. For former relationships, there must recorded on criminal histories) The person at risk may bring their be evidence of ongoing contact own support person, such as a between the person at risk and How long does it take to get a friend, relative or professional their current or former partner. This disclosure? working with them or their family. means contact that is consistent or After you have submitted your planned, and may include: application, police will assess Will I receive the disclosure? • Family Court proceedings whether there is a serious threat The disclosure will only be made in • child care arrangements to the life, health or safety of the person to the person who may be • family functions person you are applying for by at risk, unless there are exceptional doing a risk assessment of their circumstances. You may be present • mutual friends or social networks circumstances, and a criminal at the disclosure only where the • common dealing in private record check their current or former person who may be at risk invites property or business partner. you to be there as a support person. • common dealing or use of a The police will process all residence Will I be informed of the applications within two weeks. If • work or a common employer the police believe there is a serious outcome of my application? • common kinship relationships in threat to the person you are No, the police will make contact Aboriginal communities, or applying for, they will be notified of with the person who may be at risk. any relevant convictions within • living in small rural communities 48 hours. What happens if there are no where contact is unavoidable. relevant convictions? What will happen at the Where can I get more information? A support service worker will be disclosure? More information is available at available to offer support and to www.domesticviolence.nsw.gov.au/ The police will advise the person further discuss any relationship dvds. who may be at risk in person at concerns. the police station or at another Generally, domestic violence safe location. A domestic violence is under-reported, and some support service will be present to matters are withdrawn before they provide support and help plan for are finalised at court so not all their safety. perpetrators of domestic violence Any person present at a disclosure will have a criminal conviction. will be required to sign a legal The absence of a relevant criminal document stating that they will not conviction does not mean that the misuse any information disclosed. person is not at risk of domestic This means that any person who violence, and it is important that receives information must agree you report any future concerns or to not publish or spread the instances of violence to the police. information, or use the information to stalk or intimidate their current or former partner, or embarrass or humiliate them on social media or through other public networks. NSW Domestic Violence Disclosure Scheme · PAGE 2 Office use only: Application form COPS Event number NSW Domestic Violence Disclosure Scheme PART 1: PART 2: Personal details of the person who may be at risk Details of children 1. Their full name 13. Do they have children? Title (e.g. Mr, Mrs, Miss, Ms) Yes No (if no, please move to question 14) Surname Please list the names of children who live most or all of the time with the person who may be at risk. First name Child 1 Middle name Surname 2. Have they been known by another name? (please insert) First name Middle name Gender Female Male Other 3. Their gender (please select) Female Male Other Date of birth dd / mm / yyyy 4. Their address Address (only if different from person at risk) Street address Suburb Postcode Child 2 Postal address (if different) Surname First name Middle name Gender Female Male Other 5. Their contact details (for police to contact them) Date of birth dd / mm / yyyy Home phone Address (only if different from person at risk) Mobile Email address 6. Their date of birth (dd/mm/yyyy) Child 3 dd / mm / yyyy Surname First name 7. Preferred method and time for police to contact them Middle name Gender Female Male Other 8. Have they made an application before? Date of birth dd / mm / yyyy No Yes Unsure Address (only if different from person at risk) Police station dd mm yyyy Date / / Child 4 9. Their preferred language (optional) Surname First name 10. Do they need an interpreter? (optional) No Yes Middle name 11. Are they of Aboriginal or Torres Strait Islander origin? Gender Female Male Other (optional) dd mm yyyy Date of birth / / No Yes, Aboriginal Yes, Torres Strait Islander Address (only if different from person at risk) 12. Do they have a disability? No Yes NSW Domestic Violence Disclosure Scheme · PAGE 3 Child 5 18. Your contact details Surname Home phone First name Mobile Middle name Email address Gender Female Male Other dd mm yyyy Date of birth / / 19.