FORM 81A-A
rule 81A.11(2)(a)
IN THE SUPREME COURT			
OF THE NORTHERN TERRITORY 			
OF AUSTRALIA AT [DARWIN / ALICE SPRINGS]	
File No. [file number] 
BETWEEN
THE KING
and
[NAME OF ACCUSED]
APPLICATION TO THE COURT
[Applicant's full name] 
of [address] 
Application under [cite authority under which application is made, for example section 42 of the Sentencing Act 1995]
The matter to which the application relates is: [briefly specify the matter to which the application relates, for example, an application to vary conditions of a sentencing order dated [date].] 
Relief sought: [specify the order(s) that the applicant is seeking, for example to remove conditions 2 and 3 from the applicant’s suspended sentence made [date]]. 
The applicant's address for service is: [address]
Date: [date]
Signature of the [applicant / 
applicant's solicitor]
______________________________________________________________
NOTICE OF HEARING
TO:	[Name of accused] and Director of Public Prosecutions 
NOTE:  That the above matter has been listed for hearing at [Court] in the Supreme Court Building [State Square, Darwin / 14 Parsons Street, Alice Springs] on the [date] day of [month, year] at [time] when all parties to the matter must attend.
COURT OFFICER
Date: [date]