S.I. No. 93/1997 - District Court Rules, 1997

				Signed....................................................	Signed....................................................	Signed....................................................	Signed....................................................
Declared before me by	Declared before me by	................................................................................................................	................................................................................................................	................................................................................................................	................................................................................................................	................................................................................................................	................................................................................................................
†(who is personally know to me) †(who is identified to me by	†(who is personally know to me) †(who is identified to me by	†(who is personally know to me) †(who is identified to me by	†(who is personally know to me) †(who is identified to me by	†(who is personally know to me) †(who is identified to me by	†(who is personally know to me) †(who is identified to me by	.........................................................................	.........................................................................
........................................................................................................	........................................................................................................	........................................................................................................	........................................................................................................	........................................................................................................	........................................................................................................	........................................................................................................	who is personally known to me),
at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................	at ....................................................................................................................................
in the County of on this	in the County of on this	in the County of on this	day of	day of	19 .	19 .	19 .
				Signed.............................................................................	Signed.............................................................................	Signed.............................................................................	Signed.............................................................................
				Judge of the District Court (or) Peace Commissioner	Judge of the District Court (or) Peace Commissioner	Judge of the District Court (or) Peace Commissioner	Judge of the District Court (or) Peace Commissioner

• Give particulars of service

† Delete where inapplicable

No. 10.5

O.10, r.23 (3)

COURTS ACT, 1991

Section 22 (6) (a)

NOTICE OF APPLICATION TO HAVE PROCEEDINGS SET ASIDE

District Court Area of	District Court Area of	District No.	District No.	District No.

..........................................................................................................................................................Applicant of .......................................................................................................................

*(in court area and district aforesaid)

WHEREAS a summons was issued under

• section 11 (2) of the Petty Sessions (Ireland) Act, 1851 ]

• section 1 of the Courts (No. 3) Act, 1986 ]

in a case of summary jurisdiction entitled

.............................................................................................................	*Complainant
	*Prosecutor
-v-
.............................................................................................................	*Defendant
	*Accused

and said summons was for hearing at a sitting of the Court for the above-named court area on the day of 19 ,

AND WHEREAS the applicant herein is the defendant accused named in the summons,

AND WHEREAS the Court on the day of 19 , proceeded to hear the complaint accusation to which the summons related,

AND WHEREAS the applicant herein, being the person to whom the summons was directed, did not receive notice of the summons or of the hearing to which the summons related until the day of 19 , being a time after the commencement of the said hearing,

TAKE NOTICE THAT I, the said applicant, intend to apply to the District Court for the said court area, within the time specified in section 22 (6) (a) of the Courts Act, 1991 , upon the date and at the time to be fixed by you, to have the said proceedings set aside.

My address within the State for the service of documents is as shown above/ is ................................

...................................................................................................................................................................................

Dated this	day of	19 .	19 .
			Signed..................................................................
			Applicant

To the District Court Clerk for the said court area,

at the District Court Office,

..................................................

No. 10.6

O.10, r.23 (4)

COURTS ACT, 1991

Section 22 (6) (b)

NOTICE OF LISTING OF APPLICATION FOR HEARING

District Court Area of	District Court Area of	District No.	District No.	District No.

...................................................................................................................................................... Applicant

of .................................................................................................................................................................

*(in court area and district aforesaid)

WHERAS proceedings in a case of summary jurisdiction entitled

.............................................................................................................	*Complainant
	*Prosecutor
-v-
.............................................................................................................	*Defendant
	*Accused

were brought by summons before the Court on the day of 19 ,

alleging that the defendant accused did on the day of 19 , at	alleging that the defendant accused did on the day of 19 , at
......................................	*(in court area and district aforesaid)—

and the Court on the day of 19 , proceeded to hear the *complaint * accusation to which the summons related,

AND WHEREAS notice of an intended application by the above-named * defendant * accused pursuant to section 22 (6) (a) of the Courts Act, 1991 to have the said proceedings set aside has been lodged with me,

TAKE NOTICE THAT the said application has been listed for hearing at the sitting of the District Court for the said court area to be held

at........................................................................	on the	day of
19 , at a.m./p.m.
---	---	---
Dated this	day of	19 .

To

of

Complainant Prosecutor

To

of

Defendant Accused

• Delete words inapplicable

No. 10.7

O.10, r.23 (5)

COURTS ACT, 1991

Section 22 (7)

ORDER (SETTING ASIDE) (REFUSING TO SET ASIDE) PROCEEDINGS

District Court Area of	District Court Area of	District No.	District No.	District No.
................................................................................................................................................................	................................................................................................................................................................	................................................................................................................................................................	Applicant	Applicant
of	.....................................................................................................................................................	.....................................................................................................................................................	.....................................................................................................................................................	.....................................................................................................................................................

WHEREAS proceedings in a case of summary jurisdiction entitled

.............................................................................................................	*Complainant
	*Prosecutor
-v-
.............................................................................................................	*Defendant
	*Accused

were brought by summons before the Court on the day of 19 ,

alleging that the defendantaccused did on the day of 19 , at	alleging that the defendantaccused did on the day of 19 , at
......................................	*(in court area and district aforesaid)—

AND WHEREAS the Court on the day of 19 proceeded to hear the complaint accusation to which the summons related,

NOW THE COURT, on hearing an application made by the above-named defendant accused pursuant to section 22 (6) (a) of the above-mentioned Act to have the said proceedings set aside on the ground that he/she did not receive notice of the summons or of the hearing to which the summons related, and being satisfied that notice of the application was duly served upon the complainant prosecutor,

*[HEREBY REFUSES to grant the said application.]

*[HEREBY GRANTS the said application

AND DIRECTS that the complaint accusation to which it relates be heard again at the sitting of the District Court to be held at..................................on the day of

19 at a.m./p.m.]

Dated this	day of	19 .	19 .
			Signed..................................................................
			Judge of the District Court

• Delete where inapplicable

No. 14.1

O.14, r.6

CRIMINAL PROCEDURE ACT, 1967

Section 17 (2)

CERTIFICATE TO THE HIGH COURT

District Court Area of	District No.	District No.	District No.
............................................................................................................................................................	............................................................................................................................................................	Prosecutor	Prosecutor
............................................................................................................................................................	............................................................................................................................................................	Accused	Accused

An application having been made this day to me, the Judge by whom the preliminary examination herein was conducted, by the Director of Public Prosecutions pursuant to section 17 (2) of the Criminal Procedure Act, 1967 , AND IT APPEARING to me that

....................................................................................... of ........................................................................................ has

contravened section 17 (1) of that Act by publishing or causing to be published in relation to the preliminary examination of offences with which the above-named accused is charged the following information:-

I HEREBY so certify and I say that I did not permit publication of such information pursuant to section 17 (3) of the Act.

Dated this	day of	19 .	19 .
			Signed.................................................................
			Judge of the District Court

To the High Court

No. 15.1

O.15, r.1 (3)

SUMMONS

District Court Area of	District No.
---	---
.............................................................................................................................................................	.............................................................................................................................................................
of	.................................................................................................................................................
............................................................................................................................................................	............................................................................................................................................................
of	.................................................................................................................................................

*(in court area and district aforesaid)

WHEREAS a complaint has been made to me that you, on the day of 19 ,

at .................................................................................................................... *(in court area and district aforesaid)

did

THIS IS TO COMMAND YOU to appear on the hearing of the said complaint at a sitting of the District Court for the court area and district aforesaid to be held at ...................................... on the day of 19 , at a.m./p.m.

to answer to the said complaint.

Dated this	day of	19 .	19 .
			Signed..................................................................
			Judge of the District Court
---	---
To the above-named	*defendant
	*accused
of	of

• Delete words inapplicable

No. 15.2

O.15, r.2 (1)

COURTS (NO. 3) ACT, 1986

Section 1

SUMMONS

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused

WHEREAS on the day of 19 , an application was made to this office by (on behalf of) the above-named Prosecutor for the issue of a summons to you, the above-named Accused, of (in court area and district aforesaid) alleging the following offence(s):-

that you did on the	day of	19 ,
at	*(in the court area and district	*(in the court area and district
aforesaid)	aforesaid)	aforesaid)

contrary to

THIS IS TO NOTIFY YOU that you will be accused of the said offences) at a sitting of the District Court for the court area and district aforesaid to be held at ..............................................................

on the	day of	19 , at a.m./p.m.

AND TO REQUIRE YOU to appear at the said sitting to answer the said accusation(s).

Dated this	day of	19 .
---	---
at the District Court Office
at .........................................................................
	...........................................................................
	Appropriate District CourtClerk
To
of........................................................................
the above-named accused.

• Delete words inapplicable.

No. 15.3

O.15, r.1 (2)

O.16, r.1 (1)

INFORMATION

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................	.....................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................	.....................................................................................................................................................	Accused	Accused
---	---	---
The information of	The information of	............................................................................................................................
of	......................................................................................................................................................................	......................................................................................................................................................................
who says on oath	who says on oath	who says on oath

*(and the Informant binds himself/herself to attend when and where called on to give evidence against the said accused for the said offence, or otherwise to forfeit to the State the sum of to the use of the Minister for Finance).

		Signed	.............................................................
			Informant
Sworn before me this day of 19 .	Sworn before me this day of 19 .	Sworn before me this day of 19 .	Sworn before me this day of 19 .
at	.....................................................................
		Signed	.............................................................
			Judge of the District Court

• Delete words inapplicable.

No. 16.1

O.16, r.1 (2) r.6

WARRANT TO ARREST

District Court Area of	District No.	District No.	District No.
....................................................................................................................................................................	....................................................................................................................................................................	Prosecutor	Prosecutor
....................................................................................................................................................................	....................................................................................................................................................................	Accused	Accused

WHEREAS a complaint has been made on oath and in writing that †

THIS IS TO COMMAND YOU to whom this warrant is addressed to arrest the said

........................................................................................... of .............................................................................. and to bring him/her without any delay before me or another Judge to be dealt with according to law.

Dated this	day of	19 .	19 .
			Signed..................................................................
			Judge of the District Court

To the Superintendent of the Garda Síochána

at

† State nature of charge of compliant with time and place.

No. 17.1 (page 1)

O.17, r.1 (1)

District Court Area of	District No.

CHARGE SHEET

.............................................................................................................................................	Garda Síochána Station

Charge Sheet No. of 19

*Prosecutor......................................................................................................................................................................	*Prosecutor......................................................................................................................................................................	*Prosecutor......................................................................................................................................................................
*Compliant	*Compliant	*Compliant
*Accused .......................................................	*Accused .......................................................	address ...........................................................................................
*Defendant	*Defendant	*Defendant
In private prosecutions ...............................	In private prosecutions ...............................	address ...........................................................................................
signature and address of person making complaint,

*Delete words inapplicable

No. 17.1 (page 2)

O.17, r.1 (1)

*Prosecutor......................................................................................................................................................
*Compliant

*Delete words inapplicable

*Accused..................................................................................................................................
*Defendant

OFFENCE(S) CHARGED:-

No. 17.1 (pages 3 and 4)

O.17, r.1 (1)

Date	Note of Order of the Court
................................................................................................................................................................	................................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
..............................................................................................................................................................	..............................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
...............................................................................................................................................................	...............................................................................................................................................................
................................................................................................................................................................	................................................................................................................................................................

No. 17.2

O.17, r.4 (1)

CRIMINAL PROCEDURE ACT, 1967

Section 31

RECOGNISANCE TAKEN BY MEMBER OF GARDA SIOCHANA

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
......................................................................................................................................................................	......................................................................................................................................................................	Accused	Accused
---	---	---	---
We	We	We	...........................................................................
a	.........................................................................................	.........................................................................................	.........................................................................................
of	of	....................................................................................	....................................................................................
and	and	and	...........................................................................
---	---	---	---
a ....................................................	a ....................................................	severally acknowledge ourselves to owe to the State the several sums	severally acknowledge ourselves to owe to the State the several sums
following, that is to say, the said ............................	following, that is to say, the said ............................	following, that is to say, the said ............................	following, that is to say, the said ............................
...................................	and the said ................	and the said ................	the sum of ..............................
of the Minister for Finance if the above-named accused fails in the condition hereunder.	of the Minister for Finance if the above-named accused fails in the condition hereunder.	of the Minister for Finance if the above-named accused fails in the condition hereunder.	of the Minister for Finance if the above-named accused fails in the condition hereunder.
---	---
...............................................................................................................................	Accused
...............................................................................................................................	Surety
...............................................................................................................................	Surety

Acknowledged before me this day of 19 .

	Signed.................................................................
	Member of Garda Síochána

The condition of this recognisance is that the above-named accused will appear before the District Court at on the day of 19 , at .m. and any adjournment thereof until his/her presence is no longer required to answer the charge that ‡

‡ State nature of offence with time and place.

No. 17.3

O.17, r.4 (2)

CRIMINAL PROCEDURE ACT, 1967

Section 31

RECOGNISANCE TAKEN BY MEMBER OF GARDA SIOCHANA

(where a sum of money is accepted in lieu of surety or sureties)

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused
---	---	---	---
I,	.........................................................................................................................................................................	.........................................................................................................................................................................	.........................................................................................................................................................................
of ..................................................................................... ,a ..............................................................................................	of ..................................................................................... ,a ..............................................................................................	of ..................................................................................... ,a ..............................................................................................	of ..................................................................................... ,a ..............................................................................................

acknowledge myself to owe to the State the sum of .................... pounds to the use of the Minister for Finance AND in lieu of surety/sureties I have lodged the sum of................ pounds;

AND I further acknowledge that both of the said sums are liable to be forfeit to the said Minister if I fail in the condition hereunder.

	Signed..........................................................................
Acknowledged before me this day of 19	Acknowledged before me this day of 19
	Signed............................................................................
	Member of Garda Síochána

The condition of this recognisance is that the above-named accused will appear before the District Court at on the day of 19 at .m. and any adjournment thereof until his/her presence is no longer required to answer the charge that‡

‡State nature of offence with time and place

No. 18.1

O.18, r.5

O.24, r.36 (1)

CRIMINAL PROCEDURE ACT, 1967 .

Section 2

RECOGNISANCE

• (remand)

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused
---	---	---	---
We	We	We	We
a ........................................................................................... and .........................................................................................	a ........................................................................................... and .........................................................................................	a ........................................................................................... and .........................................................................................	a ........................................................................................... and .........................................................................................
of ........................................................................................... a ...........................................................................................	of ........................................................................................... a ...........................................................................................	of ........................................................................................... a ...........................................................................................	of ........................................................................................... a ...........................................................................................
and ........................................................................................ of ..........................................................................................	and ........................................................................................ of ..........................................................................................	and ........................................................................................ of ..........................................................................................	and ........................................................................................ of ..........................................................................................
---	---	---	---
a............................................ severally acknowledge ourselves to owe to the State the several sums following, that is to say, the said........................the sum of..................... pounds and the said ..............................and the said................ the sum of.......................... pounds each to the use of the Minister for Finance if the above-named accused fails in the condition hereunder.	a............................................ severally acknowledge ourselves to owe to the State the several sums following, that is to say, the said........................the sum of..................... pounds and the said ..............................and the said................ the sum of.......................... pounds each to the use of the Minister for Finance if the above-named accused fails in the condition hereunder.	a............................................ severally acknowledge ourselves to owe to the State the several sums following, that is to say, the said........................the sum of..................... pounds and the said ..............................and the said................ the sum of.......................... pounds each to the use of the Minister for Finance if the above-named accused fails in the condition hereunder.	a............................................ severally acknowledge ourselves to owe to the State the several sums following, that is to say, the said........................the sum of..................... pounds and the said ..............................and the said................ the sum of.......................... pounds each to the use of the Minister for Finance if the above-named accused fails in the condition hereunder.
---	---
.........................................................................................................................................................	Accused
.........................................................................................................................................................	Surety
.........................................................................................................................................................	Surety
---	---
Acknowledged before me this day of 19 .	Acknowledged before me this day of 19 .
	Signed..................................................................
	Judge of the District Court (or) Peace Commissioner

The condition(s) of this recognisance is/are that the above-named accused will appear before the District Court at on the day of 19 , at .m. and at every place and time to which during the course of the proceedings the hearing may be adjourned until the accused's presence is no longer required to answer the charge that‡

‡ State offence with time and place

No. 18.2

O.18, r.5

O.24, r.30

CRIMINAL PROCEDURE ACT, 1967

Section 22

RECOGNISANCE ON SENDING FORWARD FOR TRIAL OR SENTENCE

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused
---	---	---	---
We........................................................................of........................................................................................	We........................................................................of........................................................................................	We........................................................................of........................................................................................	We........................................................................of........................................................................................
a ....................................................................................... and .......................................................................................	a ....................................................................................... and .......................................................................................	a ....................................................................................... and .......................................................................................	a ....................................................................................... and .......................................................................................
of ....................................................................................... a ..........................................................................................	of ....................................................................................... a ..........................................................................................	of ....................................................................................... a ..........................................................................................	of ....................................................................................... a ..........................................................................................
and ................................................................................... of .........................................................................................	and ................................................................................... of .........................................................................................	and ................................................................................... of .........................................................................................	and ................................................................................... of .........................................................................................

a............................................ severally acknowledge ourselves to owe to the State the several sums following, that is to say, the said......................... the sum of........................... pounds and the said .............................. and the said.............. the sum of ........................... pounds each to the use of the Minister for Finance if the above-named accused fails in the condition hereunder.

.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	Accused
.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	Surety
.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	.........................................................................................................................................................	Surety
Acknowledged before me this	Acknowledged before me this	Acknowledged before me this	day of	19	19
Dated this	day of	19	19	19	19
---	---
	Signed.............................................................................
	Judge of the District Court (or) Peace Commissioner

The condition of this recognisance is that the above-named accused will appear before the ...................Court to be held at........................on the day of 19 and will not depart from the said Court without leave and will attend there in person from day to day during the time the said Court shall be so held or any adjournment thereof for the purposes of his/her [image omitted]and also attend any other Court to which the trial may be transferred until the charge against

him/her namely‡

shall be duly disposed of according to law.

*Delete whichever inapplicable

‡State offence with time and place

No. 18.3

O.18, r.6

O.24, r.36

CRIMINAL PROCEDURE ACT, 1967

Section 26

RECOGNISANCE

(where a sum of money is accepted in lieu of surety or sureties) (remand)

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused

I, ............................................................................................................................................................................... of....................................................................... ,a .......................................................................................................

acknowledge myself to owe to the State the sum of ............ pounds to the use of the Minister for Finance AND in lieu of surety/sureties I have, pursuant to the direction of the Judge lodged the sum of ................... pounds;

AND I further acknowledge that both of the said sums are liable to be forfeited to the said Minister if I fail in the condition hereunder.

	Signed...........................................................................
Acknowledged before me this day of 19	Acknowledged before me this day of 19
	Signed..........................................................................
	Judge of the District Court (or) Peace Commissioner

The condition of this recognisance is that the above-named accused will appear before the District Court at on the day of 19 at .m. and at every place and time to which during the course of the proceedings the hearing may be adjourned until the accused's presence is no longer required to answer the charge that*

*State nature of offence with time and place

I hereby certify that in lieu of surety/sureties the above-named...................................... has this day lodged with me, pursuant to the direction of the Judge, the sum of £

Dated this	day of	19 .	19 .
			Signed..................................................................
			District Court Clerk
			(or)
			Governor of......................... Prison

No. 18.4

O.18, r.6

O.24, r.30

CRIMINAL PROCEDURE ACT, 1967

Section 26

RECOGNISANCE

(sending forward for trial or sentence)

(where a sum of money is accepted in lieu of surety or sureties)

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused

I, ................................................................................................................................................................................ of ................................................................... ,a ...............................................................................................................

acknowledge myself to owe to the State the sum of .........pounds

to the use of the Minister for Finance AND in lieu of surety/sureties I have, pursuant to the direction of the Judge sending me forward for [image omitted], lodged the sum of ............... pounds;

AND I further acknowledge that both of the said sums are liable to be forfeit to the said Minister if I fail in the condition hereunder.

	Signed............................................................................
Acknowledged before me this day of 19	Acknowledged before me this day of 19
	Signed............................................................................
	Judge of the District Court (or) Peace Commissioner

The condition of this recognisance is that the above-named accused will appear before the ................... Court to be held at ........................... on the day of 19 and will not depart from the said Court without leave and will attend there in person from day to day during the time the said Court shall be so held or any adjournment thereof for the purposes of his/her [image omitted]and also attend any other Court to which the trial may be transferred until the charge against

him/her namely‡

shall be duly disposed of according to law.

I hereby certify that in lieu of surety/sureties the above-named.............. has this day lodged with me, pursuant to the direction of the Judge, the sum of £

Dated this	day of	19 .	19 .
			Signed..................................................................
			District Court Clerk
			(or)
			Governor of .........................Prison

• Delete words inapplicable

†State offence with time and place

No. 18.5

O.18, r.21

REQUEST TO PLACE LODGMENT ON DEPOSIT ACCOUNT

District Court Area of	District Court Area of	District No.	District No.
.....................................................................................	v.	v.	.......................................................................................

TAKE NOTICE that I,

of

have to-day paid into Court the sum of †£,

being in respect of*
	*(give here details of nature of lodgment)

and I hereby request that the said sum be placed on a deposit account.

Dated this	day of	19 .	19 .
			Signed..................................................................

†if it exceeds £150

No. 18.6

O.18, r.10

CERTIFICATE THAT CONDITION(S) OF RECOGNISANCE HAVE BEEN PERFORMED

.....................................................................................................................................................................	Prosecutor
.................................................................................................................................	Accused

On the day of 19 the above-named accused

entered into a recognisance conditioned that he would*

In lieu of a surety or sureties ............................................................................................................................ of .........................................................................................................................................................

lodged the sum of £

I now hereby certify that the conditions(s) of the recognisance have been performed.

Dated this	day of	19 .	19 .
			Signed..................................................................
			Judge of the District Court

*Insert condition(s)

No. 18.7

O.18, r.12

O.19, r.4

WARRANT TO PRODUCE ACCUSED

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused

SEND in custody the above-named accused who was committed on the day of 19 , to the sitting of the District Court at................................... on the day of 19 at .m.

for the purpose of [image omitted]

Dated this	day of	19 .	19 .
			Signed..................................................................
			Judge of the District Court

To the [image omitted] of the [image omitted]

at

*Delete whichever inapplicable

No. 18.8

O.18, r.12

CERTIFICATE OF CONSENT TO BAIL

District Court Area of	District No.	District No.	District No.
.....................................................................................................................................................................	.....................................................................................................................................................................	Prosecutor	Prosecutor
.....................................................................................................................................................................	.....................................................................................................................................................................	Accused	Accused

WHEREAS .................................................................................................................... of .......................................................................................

was on the day of 19 , committed by the Court

to the [image omitted] .................................. at ..................................

charged

The Court hereby consents to the said .................................................................... being conditionally released on his/her entering into a recognisance himself/herself in the sum of and one sufficient surety in the sum of £ or two sufficient sureties in the sum of £ each

†(and further consents that in lieu of such surety or sureties