Apply for a Police Review of a Police Protection Direction online

Please note: A copy of this application will be provided to the aggrieved, respondent and may be given to any named person.

Please fill in all required fields marked with an *.

Applicant Details

Applicant involvement*

Aggrieved

Authorised person for the Aggrieved

Respondent

Named person

Family Name*

Given Name(s)*

Date of Birth*

Important:

It is important to provide a safe method for the QPS to contact you regarding this application.

You should not provide an email address where a person other than yourself has access to or knows the password. This may include where you suspect the person may have access to your accounts without your permission.

By including an email address, phone number and/or residential address, you confirm that this is a safe and appropriate way to communicate with you.

Email*

I agree to share this email with other parties of this PPD.

Phone number

I agree to share this phone number with other parties of this PPD.

Residential address

Street Address

Suburb

State

Postal Code

I agree to share this address with other parties of this PPD.

Police Protection Direction Details (subject to this application)

Occurrence Number (QP No.)

Date issued

Details of the issuing officer

Family name of the aggrieved *

Given name of the aggrieved*

Date of Birth of the aggrieved

Family name of the respondent*

Given name of the respondent*

Date of Birth of the respondent

Application timeframe

Is this application made within the prescribed period namely the 28 days of the service of the grounds of the Police Protection Direction on the respondent?*

Yes

No or unsure

Give reasons you are seeking an extension of the time to make an application for Police Review.

If this application is not made within the prescribed period and/or no extension granted, and a Police Review is not initiated under section 100T, you will be notified.

Application outcome sought

Note: The Reviewing Officer will consider your requested outcome, and may consider any other submissions or information received from you or others in the conduct of the Police Review. When deciding the outcome of the Police Review the Reviewing Officer must select from one of the following options. The decision made may be different from your requested outcome. Include reasons why you believe any of these options should not be selected by the Reviewing Officer.

What outcome are you (the applicant) seeking?

Revoke the PPD and issue a new PPD with different conditions or different named persons (specify)

Revoke the PPD and issue a Police Protection Notice

Revoke PPD and make application to a Court for a Protection Order (DV01)

Confirm PPD (make no change)

Revoke the PPD and take other appropriate action not involving seeking a Protection Order (e.g. taking the respondent to a hospital to receive treatment)

Revoke the PPD and take no other action

Give reasons you are seeking this outcome of the Police Review

Application outcome sought

Note: The Reviewing Officer will consider your requested outcome, and may consider any other submissions or information received from you or others in the conduct of the Police Review. When deciding the outcome of the Police Review the Reviewing Officer must select from one of the following options. The decision made may be different from your requested outcome. Include why you say any of these options should not be selected by the Reviewing Officer.

What outcome are you (the applicant) seeking?

Changing condition(s) included on the PPD relating to the named person (me)

Removing the named person (me) from the PPD

Give reasons you are seeking this outcome of the Police Review

Additional information

Is there any additional information you would like to include for consideration in the Police Review?

Declaration

Warning: Giving false or misleading information or document is an offence.

I, declare that:

I understand a copy of this application will be provided to the aggrieved, the respondent, and may be given to a named person;
I understand that the Police Review must be decided only on the circumstances that existed when the Police Protection Direction was issued. However, the reviewing officer may take into consideration circumstances that existed, but were not known to the issuing officer at the time the Police Protection Direction was issued. This means anything that happened after the Police Protection Direction was issued cannot be considered in the Police Review;
I understand that the making of an application for a Police Review of a Police Protection Direction does NOT change the need to comply with the Police Protection Direction. Contravening the Police Protection Direction is an offence. Maximum penalty is 3 years imprisonment or a fine of 120 penalty units;
I understand a decision on the Police Review will be made within 28 days of the Police Review commencing, unless the Police Review is or must be discontinued;
I understand that if an application for a Court Review is filed or commenced during a Police Review, then the Police Review is or must be discontinued immediately.

I declare that the information that I have provided in this form is true and correct to the best of my knowledge and I acknowledge I am liable for prosecution if the information given is false or misleading.

Location of declaration*