Western Australian Consolidated Regulations

MAGISTRATES COURT (GENERAL) RULES 2005 - SCHEDULE 2

[r. 3]

1A.         Application for leave to lodge a document (r. 10)

Magistrates Court Act 2004 s. 17(3) Magistrates Court at No:			Application for leave to lodge a document
Applicant	Full name
	Address
	Telephone			Fax
	Email address
Case details	Case No.				Civil/Criminal
	Parties
Document to be lodged
Application	I am a party to the above case and I would like leave to lodge the above document.
Signature of applicant				Date

        [Form 1A inserted in Gazette 23 Nov 2007 p. 5864.]

1B.         Appeal against registrar’s decision (r. 26)

Magistrates Court Act 2004 s. 29 Magistrates Court at No:				Appeal against registrar’s decision
Appellant	Full name
	Address
	Telephone				Fax
	Email address
Case details	Case No.						Civil/Criminal
	Parties
Decision being appealed	Date of decision
	Brief description of decision
Appeal	Under the Magistrates Court Act 2004 section 29 the appellant appeals against the above decision.
Extension of time	Is this application lodged within 21 days after the date of the above decision? Yes/No If no, state why the application is lodged late:
Grounds of appeal	1.
Signature of appellant or lawyer	Appellant/Appellant’s lawyer					Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

        [Form 1B inserted in Gazette 23 Nov 2007 p. 5864.]

1.         Request to inspect or obtain copy of document from the Court (r. 37)

Magistrates Court Act 2004 s. 33(3), (7) Magistrates Court at No:			Request to inspect or obtain copy of document from the Court
Person making the request	Full name
	Address
	Telephone			Fax
	Email address
Case details	Case No.				Civil/Criminal
	Parties
Documents wanted
Request by a party [Delete if not applicable.]	I am a party to the above case and I would like —         to inspect;         to obtain a copy of, the above documents.
Request by non‑party	I am not a party to the above case. I would like —         to inspect;         to obtain a copy of, the above documents because the case is a criminal case and I am a person referred to in the Magistrates Court Act 2004 s. 33(7), namely — [give details].
Signature of person making the request				Date

        [Form 1 inserted in Gazette 8 Apr 2008 p. 1338.]

2.         Application for leave in respect of court record (r. 38)

Magistrates Court Act 2004 s. 33(4) Magistrates Court at No:			Application for leave in respect of court record
Applicant	Full name
	Address
	Telephone			Fax
	Email address
Case details	Case No.				Civil/Criminal
	Parties
Records wanted
Application 1	I am a party to the above case and, under the Magistrates Court Act 2004 s. 33(4), I apply for leave —
Signature of applicant				Date

Notes to Form 2 —
1.         Set out in detail what the applicant wants leave to do.

        [Form 2 amended in Gazette 8 Apr 2008 p. 1338.]

3A.         Application for access to information held by the Court (r. 39)

Magistrates Court Act 2004 s. 33(8) Magistrates Court at No:			Application for access to information held by the Court
Applicant	Full name
	Address
	Telephone			Fax
	Email address
Case details	Case No.				Civil/Criminal
	Parties
Information wanted
Application	I would like —         to inspect;         to obtain a copy of;         to view or listen to, the above information. [Set out grounds for the request.]
Signature of applicant				Date

        [Form 3A inserted in Gazette 8 Apr 2008 p. 1339.]

3.         Application to cancel licence suspension order made in respect of infringement notice (r. 48)

Fines, Penalties and Infringement Notices Enforcement Act 1994 s. 101 Magistrates Court at No:				Application to cancel licence suspension order made in respect of infringement notice
Applicant	Full name
	Address
	Date of birth
Licence suspension details	Prosecuting authority
	Infringement notice No.
	Registry case No.
	Licence suspended [Tick one box]		Driver’s licence No.         Vehicle licence No.         All vehicle licences
Application [Tick one box] [*delete one]	I, the applicant, have been disqualified from holding or obtaining the above licence(s) by a licence suspension order made under the Fines, Penalties and Infringement Notices Enforcement Act 1994 Part 3. Under section 101 of that Act I apply for an order cancelling the licence suspension order on the grounds that I received none of the following — (a)         the infringement notice that gave rise to the licence suspension order; (b)         the final demand issued under section 14 of the Act in respect of the infringement notice; (c)         the order to pay or elect issued under section 17 of the Act in respect of the infringement notice; (d)         the notice of intention to suspend licences issued under section 18 of the Act in respect of the infringement notice; (e)         the notice confirming licence suspension issued under section 19(6) of the Act in respect of the infringement notice.
Certificate	I certify that I have not previously made an unsuccessful application under section 101 of the Act in relation to this licence suspension order or in relation to any other licence suspension order made in respect of this infringement notice.
Signature of applicant					Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

4.         Application to cancel licence suspension order made in respect of a fine (r. 49)

Fines, Penalties and Infringement Notices Enforcement Act 1994 s. 101A Magistrates Court at No:				Application to cancel licence suspension order made in respect of a fine
Applicant	Full name
	Address
	Date of birth
Licence suspension details	Sentencing Court
	Charge No.
	Registry case No.
	Licence suspended [Tick one box]		Driver’s licence No.         Vehicle licence No.         All vehicle licences
Application [Tick one box] [*delete one]	I have been disqualified from holding or obtaining the above licence(s) by a licence suspension order made under the Fines, Penalties and Infringement Notices Enforcement Act 1994 Part 4. Under section 101A of that Act I apply for an order cancelling the licence suspension order on the grounds that — (a)         I did not receive a summons or a notice to attend court in respect of the charge that gave rise to the fine that gave rise to the licence suspension order; (b)         I was not present in court when that fine was imposed; and (c)         I received neither of the following — (i)         the notice of intention to suspend licences issued under section 42 of the Act in respect of that fine; (ii)         the notice confirming licence suspension issued under section 43(6) of the Act.
Certificate by applicant	I certify that I have not previously made an unsuccessful application under section 101A of the Act in relation to this licence suspension order or in relation to any other licence suspension order made in respect of this fine.
Signature of applicant					Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

4A.         Application for an order for seized keys to be handed over (r. 50A)

Road Traffic Act 1974 s. 71B(7) Magistrates Court at No:			Application for an order for seized keys to be handed over
Applicant	Full name
	Address
Person described in s. 71B(5) of the Act	Full name
	Address
Application	The applicant applies for an order for the seized keys to be handed over to the applicant.
Seized keys 1
Signature of applicant or lawyer	Applicant/Applicant’s lawyer			Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Notes to Form 4A —
1.         Set out the details of the seizure and a description of the vehicle to which the keys relate.

        [Form 4A inserted in Gazette 23 Nov 2007 p. 5865; amended in Gazette 3 Oct 2008 p. 4486.]

5.         Application for extraordinary licence (r. 51(1))

Road Traffic Act 1974 s. 76(1) Magistrates Court at No:				Application for extraordinary licence
Applicant	Full name
	Address
	Date of birth
	Occupation
	Employment [Tick one box]	Self employed Not employed         Employed by the employer below
	Employer’s name and address
Details of disqualification from holding or obtaining a driver’s licence	Date disqualified
	Period disqualified
	Reason 1
Application	Under the Road Traffic Act 1974 s. 76(1) I apply for an order directing the Director General to grant an extraordinary licence that allows me to drive — •         vehicles of class: •         in these localities: •         on these days at these times: •         for these purposes:
Grounds for this application 2	1.
Certificate by applicant	A licence suspension order made under the Fines, Penalties and Infringement Notices Enforcement Act 1994 is not in force against me. I have not been refused an extraordinary licence by a court within the 6 months before the date of this application.
Signature of applicant					Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Notes to Form 5 —
1.         If disqualified by a court after being convicted of an offence, state the court and the offence and, if the offence was against the Road Traffic Act 1974 s. 63, 64, 67 or 67A, state whether the conviction was the applicant’s first, second or subsequent for the offence.
        If disqualified for some other reason, give details.
2.         State the hardship and inconvenience that would result if this application were refused. Note the Road Traffic Act 1974 s. 76(3). Use numbered paragraphs.

        [Form 5 amended in Gazette 23 May 2008 p. 1992; 15 Feb 2011 p. 538.]

[ 6.         Deleted in Gazette 15 Feb 2011 p. 538]

7.         Application by holder to vary extraordinary licence (r. 51(3))

Road Traffic Act 1974 s. 76(7)(a) Magistrates Court at No:				Application by holder to vary extraordinary licence
Applicant	Full name
	Address
Extraordinary licence details	Court that ordered it
	Date of court order
	Licence’s limitations and conditions
Application [Tick one box]	I hold the above extraordinary licence. Under the Road Traffic Act 1974 s. 76(7)(a) I apply for —         An order that varies the above limitations and conditions by:         An order that cancels the above limitations and conditions and substitutes these limitations and conditions:
Grounds for this application 1	1.
Signature of applicant					Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Notes to Form 7 —
1.         Note the Road Traffic Act 1974 s. 76(9)(a). Use numbered paragraphs.

8.         Application by Director General to vary extraordinary licence (r. 51(4))

Road Traffic Act 1974 s. 76(7)(b) Magistrates Court at No:			Application by Director General to vary extraordinary licence
Extraordinary licence details	Holder’s name
	Holder’s address
	Court that ordered it
	Date of court order
	Licence’s limitations and conditions
Application [Tick one box]	Under the Road Traffic Act 1974 s. 76(7)(b) the Director General applies for —         An order that varies the above limitations and conditions by:         An order that cancels the above limitations and conditions and substitutes these limitations and conditions:         An order that cancels the above extraordinary licence.
Grounds for this application 1	1.
Signature of applicant	for Director General			Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Notes to Form 8 —
1.         Note the Road Traffic Act 1974 s. 76(9). Use numbered paragraphs.

9 .         Application by owner for delay of sale of uncollected vehicle and/or return of item (r. 51A)

Road Traffic Act 1974 s. 80J(5) & (6) Magistrates Court at No:			Application by owner for delay of sale of uncollected vehicle and/or return of item
Applicant (Owner)	Full name
	Address
Uncollected vehicle/item	Registration No.
	Description of item
Application [Tick applicable box(es)]	I apply for —         An order that the sale or disposal of the uncollected vehicle not take place until after: 1.         An order that the item be returned.
Signature of applicant or lawyer	Applicant or lawyer			Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Notes to Form 9 —
1.         Specify until when you want the sale delayed. The sale cannot be delayed later than 3 months after the day of the order you are seeking.

        [Form 9 inserted in Gazette 3 Oct 2008 p. 4486‑7.]

10.         Application for decision on whether information in seized record is privileged (r. 56)

Criminal Investigation Act 2006 Magistrates Court at No:			Application for decision on whether information in seized record is privileged
Applicant	Full name
	Address
Person entitled to possession of the record	Full name
	Address
Application	The applicant applies for a decision on whether information in the seized record(s) set out below is privileged.
Seized record(s) 1
Privilege claimed 2
Signature of applicant or lawyer	Applicant/Applicant’s lawyer			Date
Hearing details	This application will be heard — on [ date ] at [ time ] or as soon after as possible, at [ place ]

Note to Form 10 —
1.         Set out a description of the seized record or records.
2.         Set out the basis or bases upon which the person entitled to possession of the record(s) claims that information in the record(s) is privileged and lodge the record(s) with this application.

        [Form 10 inserted in Gazette 24 Aug 2007 p. 4327.]