IN THE SUPREME COURT
OF THE NORTHERN TERRITORY
OF AUSTRALIA AT
[DARWIN or ALICE SPRINGS] 

File No. [file number]		

BETWEEN
THE KING
and
[NAME OF DEFENDANT]

AFFIDAVIT OF SERVICE

I, [full name], of [address] make oath and say that: 
1.	On [date], at [time], at [address], I served the defendant, [full name], with this summons by [where applicable: delivering a copy of the summons to the defendant personally / putting a copy of the summons down in the defendant's presence and telling [him/her] the nature of the document / delivering a copy of the summons to the defendant's legal representative / delivering a copy of the summons to a correctional officer [name of correctional officer] at [name of the correctional centre]]. 

2.	[state facts constituting service].
MADE at [Place]
in the Northern Territory of Australia
by [Full name of Deponent]			…………………………………              
on [date]						Signature of Deponent

BEFORE ME:

………………………………………                            			
Commissioner for Oaths/
Justice of the Peace

Name: [Name of Commissioner for Oaths / Justice of the Peace]
Address or phone number: [Address or phone number of Commissioner for Oaths / Justice of the Peace]