FORM 81A-K
rule 81A.41(4)

File No: [file number]
ORDER TO RELEASE ON GIVING OF SECURITY
[Offender's name in full]
of [address] 
came before this Honourable Supreme Court of the Northern Territory of Australia at [Darwin / Alice Springs] on [date] and was found guilty of the following offence(s): 
CASE & OFFENCE NOS	
OFFENCE	
File number	[No]	[offence]	

and the Court ordered that:
1. 	The offender be released immediately on giving $[amount] security, to:
(a)	appear before the Court if called on to do so during the period of [period of bond]; and
(b)	be of good behaviour during that period.
2. 	Other conditions ordered:
[state conditions]
I acknowledge that the conditions have been explained to me and I understand them and consent to them.
Signature of offender
Signed by the offender at [Darwin / Alice Springs] on [date].
DEPUTY SHERIFF