7. I depose to the facts stated above verily believing them to be true and correct to the best of my knowledge and information. *SWORN/*AFFIRMED by the said..................................) At ..............................this........................) __________________ Day of ....................................................) Before me:..................................................... Commissioner for Oaths *Delete as applicable 22nd January, 2016 Statutory Instruments 191 Form II (Rule 9(1)) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) SUMMONS FOR PROTECTION ORDER LET ALL PARTIES concerned attend before the Honourable Mr. / Ms. __________________________on ________day of ___________ 20__________at __________ hours on the hearing of an application to issue a Protection Order against the Respondent(s)for reasons specified in the accompanying Complaint Form filed herewith. /Mrs. Dated at ____________on the _____ day of ________________ 20 ____________ Taken out by _________________________________ (Applicant) (Indicate address for service) To :__________________________________________ (Respondent) (Indicate address) LET THE ABOVE NAMED Respondent(s)/and or Associate Respondent(s) within 14 days after service of this Application upon them, inclusive of the day of such service, cause a response to be entered for them to this Application. ________________________ Magistrate 192 Statutory Instruments 22nd January, 2016 ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ____________________________on the____ day of ______________ 20 _________ at _______________________________ (place) *This Application has not been served because —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— Date _____________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ Signature_______________________ Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate 22nd January, 2016 Statutory Instruments 193 Form III (Rule 10 (2)) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) SUMMONS FOR LEAVE TO ISSUE PROTECTION ORDER WITHOUT CONSENT OF THE VICTIM LET THE PARTY concerned attend the Honourable Mr./Mrs./Ms. __________________________on the ________day of ___________ 20__________at __________ hours on the hearing of an application for leave to issue a Protection Order against the Respondent(s) without consent of the victim for reasons specified in the accompanying affidavit filed herewith. before Dated at ____________on the _____ day of ________________ 20 ____________ Taken out by ______________________________ (Applicant) (Indicate address for service) To :_________________________________________ (Respondent) (Indicate address) LET THE ABOVE NAMED Respondent(s)/and or Associate Respondent(s) within 14 days after service of this Application upon them, inclusive of the day of such service, cause a response to be entered for them to this Application. ________________________ Magistrate 194 Statutory Instruments 22nd January, 2016 ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ____________________________on the____ day of ______________ 20 _____ at _______________________________ (place) *This Application has not been served because —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— ——————————————————— Date _______________________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ ___________________ Signature Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate Dated at ____________on the _____day of _______(year) 22nd January, 2016 Statutory Instruments 195 Form IV (Rule 11 (2)) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) EX PARTE SUMMONS FOR INTERIM PROTECTION ORDER LET THE PARTY concerned attend before the Honourable Mr./Mrs./Ms. __________________ on the ……………………. Day of ……………….. 20 …… at …………………… hours on the hearing of an application for an interim protection order against the Respondent for reasons specified in the accompanying affidavit filed herewith. Dated at ____________on the _____ day of ________________ 20 ____________ Taken out by ____________________________ (Applicant) (Indicate address for service) To :__________________________ (Respondent) (Indicate address) ________________________ Magistrate ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ____________________________ on the____ day of ______________ 20 _____ at _______________________________ (place) 196 Statutory Instruments 22nd January, 2016 *This Application has not been served because —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— Date _____________________ ________________________________________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ Signature Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate 22nd January, 2016 Statutory Instruments 197 Form V (Rule 12 (2)) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) SUMMONS FOR REVOCATION OR MODIFICATION OF PROTECTION ORDER LET ALL PARTIES concerned attend before the Honourable Mr./Mrs./Ms. __________________________on ________day of ___________ 20__________at __________ hours on the hearing of an application by the ________________ (state whether Applicant or Respondent) for (state whether cancellation or modification) of Protection Order. Dated at ____________on the _____ day of ________________ 20 ____________ Taken out by _______________________________ (Applicant) (Indicate address for service) To: ________________________________________ (Respondent) (Indicate address) ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ______________ on the__________________ day of ________________________ 20 _____ at ___________ (place) *This Application has not been served because ______________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Date _____________________ 198 Statutory Instruments 22nd January, 2016 ________________________________________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ ___________________ Signature Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate 22nd January, 2016 Statutory Instruments 199 Form VI (Rule 13) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) SUMMONS FOR EXTENSION OF PROTECTION ORDER TO OTHER PERSON LET ALL PARTIES concerned attend before the Honourable Mr./Mrs./Ms. __________________________on ________day of ___________ 20__________at __________ hours on the hearing of an application by the ________________ (state whether Applicant or Respondent) for (extension of protection order to _____________________ for the reasons specified in the accompanying affidavit. Dated at ____________on the _____ day of ________________ 20 ____________ Taken out by __________________________________ (Applicant) (Indicate address for service) To: ______________________________________ (Respondent) (Indicate address) ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ______________ on the__________________ day of ________________________ 20 _____ at ___________ (place) 200 Statutory Instruments 22nd January, 2016 *This Application has not been served because ——————————————————— —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— Date _____________________ ________________________________________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ ___________________ Signature Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate 22nd January, 2016 Statutory Instruments 201 Form VII (Rule 18) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 SUMMONS TO DISCHARGE PROTECTION ORDER LET ALL PARTIES concerned attend before the Honourable Mr./Mrs./Ms. __________________________on the________ day of ___________ 20__________at __________ hours on the hearing of an application to discharge Protection Order by the ______________ (specify whether applicant, Respondent or person specified in the Protection order) for reasons specified in the accompanying Affidavit. Dated at _______________________on the _____ day of ____________20____ Taken out by ________________________________ (Applicant) (Indicate address for service) To: ________________________________________________ (Respondent) (Indicate address) ENDORSEMENT OF SERVICE OR NON-SERVICE (ON DUPLICATE) *The original of this Application was served by me on the said ____________________________on the____ day of ______________ 20 _____ at————————————————————————————————————— (place) *This Application has not been served because —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— Date _____________________ 202 Statutory Instruments 22nd January, 2016 ________________________________________________ Signature of person required to serve Application (ON SUBSEQUENT SERVICE) * Delete item not applicable. (See Reverse for Other Endorsements) [On reverse] ENDORSEMENTS If Respondent is in different District, outside area of jurisdiction of the authorised officer within whose area of jurisdiction the issuing court is situated, endorsement by authorised officer. Date Stamp Endorsed: ______________________________________ ___________________ Signature Endorsement by officer within whose area of jurisdiction Application is to be served. Date Stamp Endorsed: __________________________________ ________________________ Magistrate Dated at ____________on the _____day of _______(year) 22nd January, 2016 Statutory Instruments 203 Form VIII (Rule 33 (2)) REPUBLIC OF ZAMBIA Anti-Gender-Based Violence Act, 2011 Anti-Gender-Based Violence (Gender Based Violence) Court Rules, 2016 (General Title) NOTICE OFAPPEAL Between A.B., Applicant and C.D., Respondent To the Registrar of the High Court TAKE NOTICE that the named Appellant hereby appeals to the High Court on the following grounds. GROUNDS OF APPEAL (state grounds of appeal below) —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— —————————————————————————————————————— Dated at ______________________on the _____ day of ____________20________________ Taken out by __________________________________ (Appellant) (Indicate address for service) To: __________________________ (Respondent) (Indicate address) JUSTICE I. C. MAMBILIMA, Chief Justice LUSAKA 20TH JANUARY , 2016 [ MGCD. 74/2/1] 204 Statutory Instruments 22nd January, 2016