Charge-sheet and warrant to arrest
Form 5 Charge-sheet and warrant to arrest
Rule 13(e)
Charge-Sheet and Warrant to Arrest
Details of accused
Name:
Gender:
Date of birth:
Accused identifies as:
🞏 Aboriginal 🞏 Torres Strait Islander 🞏 Both 🞏 Neither
Mobile phone number:
Email address:
Registration number of vehicle: State registered:
Driver licence number: State issued:
To the accused:
You have been charged with an offence.
Read these pages to see what you must do.
Details of the charge against you
What is the charge?
[Description of offence]
| Section or Clause |
Under what law? | 🞏 State | 🞏 Act | Regulation No. | (Full Ref.) |
🞏 Common-wealth | 🞏 Regulation |
🞏 Other— |
Type of offence | 🞏 Summary offence | 🞏 Indictable offence | ||
Request for committal proceeding | 🞏 No | 🞏 Yes | ||
Who filed the charge-sheet(s)?
Name of informant:
Agency and address:
Telephone:
Email:
Agency Ref.:
Signature of informant:
Date:
Charge-sheet filed at:
Date:
Request for issue of a warrant to arrest
I apply for the issue of a warrant to arrest on the following grounds:
[insert grounds]
Warrant to arrest
To all police officers:
You are authorised to break, enter and search any place where the person named in this warrant is suspected to be, to arrest that person and bring the person before a Bail Justice or the Court as soon as practicable to be dealt with according to law or cause the person to be released on bail in accordance with the endorsement on this warrant.
I am satisfied by the evidence before me that a warrant should be issued on the following grounds:
🞏 it is probable the person will not answer a summons
🞏 the person has absconded or is likely to abscond
🞏 the person is avoiding the service of a summons
🞏 the warrant is 🞏 required 🞏 authorised by another Act namely
🞏 other
Issued at: Date:
Before:
Registrar:
Magistrate:
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