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The PDF and below information provides a guide on completing the Magistrates Court's Form 12 in situations arising from family and domestic violence. Use this guide when you wish to make a court application to:

• recognise you as a tenant under the tenancy agreement;
• have someone who has committed family violence taken off your lease; 
• determine your rights and liabilities for debt and/or damages and disposal of a share of the security bond.

Applicant:

• Tick 'Tenant',
• Complete your name,
• Fill out an address where the court and other parties can send documents to you about this matter. If you are worried about your safety, you can use a PO Box or an email address.  

Respondent:

• Tick 'Lessor',
• You need to put the landlord’s name here (not the property manager). You also need to name all co-tenants and include their addresses separately. You can do this on a separate piece of paper.

Address of rented premises:

This is the address of the rented premises related to this application

Bond Reference Number

You need to put the number from your bond receipt.

Reasons for application:

You should give back ground information here about the family violence, including the dates between which the violence has occurred. Also insert here reference to the section of the Residential Tenancies Act 1987 that is relevant to your application:

• Section 59C: Be recognised as a tenant under the tenancy agreement.
• Section 71AE:  have the perpetrator’s interest in the tenancy agreement terminated on the grounds of family violence.
• Section 17B: have your rights and liabilities for debt and/or damages determined by the court and disposal of a share of the security bond

Visit Tenancy WA for more information. Alternatively you can call Tenancy WA on 9221 0088 or country freecall 1800 621 888.

Order required:

You need to write here the decisions you want the court to make. Like in the previous section, it is better if you reference the section of the Residential Tenancies Act 1987 that is relevant to the order you want made.

• Section 59C: Be recognised as a tenant under the tenancy agreement.
• Section 71AE:  have the perpetrator’s interest in the tenancy agreement terminated on the grounds of family violence.
• Section 17B: have your rights and liabilities for debt and/or damages determined by the court and disposal of a share of the security bond

Visit Circle Green Community Legal (the new home of Tenancy WA) for more information. Alternatively you can call Circle Green on (08) 9221 3636 or country freecall 1800 621 888.

Signature of applicant

You must sign the form.