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E read the accompanying notes as you complete this form. 1 About you (the applicant) State your title (Mr, Mrs etc), full name, address, telephone number and date of birth (if under 18): State your solicitor s name, address, reference, telephone, FAX and DX numbers: 2 About the respondent State the respondent s name, address and date of birth (if known): 3 The Order(s) for which you are applying This application is for: a non-molestation order an occupation order Tick this box if you wi.

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