Witness Statement — Non-Molestation Order Application
A witness statement in support of an application for a non-molestation order under Part IV of the Family Law Act 1996.
This template was not drafted by a solicitor.
It is an editorial reference based on the official sources we cite. You are responsible for any document you send. For high-stakes matters (court proceedings, large sums, deportation, criminal allegations, child welfare), have a regulated solicitor review or draft your document.
When to use this template
Use this template when you are applying to the family court for a non-molestation order to protect yourself or a child from molestation, harassment, intimidation, or violence by an associated person (such as a partner, ex-partner, or family member). The witness statement is filed alongside Form FL401 and must set out the conduct complained of in detail.
When NOT to use this template
Do not use this template without also completing Form FL401. If you are in immediate danger, call 999 — this court application process takes time. If you need protection from a non-associated person, a non-molestation order may not be available and you should consider a harassment injunction under the Protection from Harassment Act 1997 instead.
Legal Basis
Family Law Act 1996 Part IV, ss.42–44 (non-molestation orders); Family Procedure Rules 2010 Part 10 and Practice Direction 10A; breach of a non-molestation order is a criminal offence under FLA 1996 s.42A (maximum 5 years' imprisonment).
Before you send
- Not providing specific dates, locations, and descriptions of incidents — vague allegations are less persuasive and may be challenged
- Omitting incidents involving the children even if the order is primarily sought to protect yourself
- Failing to explain the relationship with the respondent — the court must be satisfied you are 'associated persons'
Common Mistakes to Avoid
- ✗Not providing specific dates, locations, and descriptions of incidents — vague allegations are less persuasive and may be challenged
- ✗Omitting incidents involving the children even if the order is primarily sought to protect yourself
- ✗Failing to explain the relationship with the respondent — the court must be satisfied you are 'associated persons'
- ✗Not requesting an occupation order separately if you also need the respondent excluded from the home
- ✗Assuming the statement alone is sufficient — the FL401 form must also be completed
Build Your Letter
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Letter preview
IN THE FAMILY COURT AT [COURT NAME] Case Number: [CASE NUMBER (IF ALREADY ALLOCATED)] **IN THE MATTER OF AN APPLICATION BY [YOUR FULL NAME (APPLICANT)]** --- **WITNESS STATEMENT OF [YOUR FULL NAME (APPLICANT)]** **In Support of Application for Non-Molestation Order (Form FL401)** I, [YOUR FULL NAME (APPLICANT)], of [YOUR ADDRESS], WILL SAY as follows: 1. I am the Applicant in these proceedings. I make this statement in support of my application for a non-molestation order against [RESPONDENT'S FULL NAME] (the "Respondent"). The facts stated in this statement are within my own knowledge and are true. 2. **My relationship with the Respondent.** [DESCRIPTION OF YOUR RELATIONSHIP WITH THE RESPONDENT]. We are associated persons within the meaning of section 62 of the Family Law Act 1996 because [WHY YOU ARE 'ASSOCIATED PERSONS']. 3. **The Respondent's conduct.** I set out below a chronological account of the incidents of molestation, harassment, and/or violence which have led me to make this application. [CHRONOLOGICAL ACCOUNT OF INCIDENTS] 4. **Impact on me and any children.** The Respondent's conduct has had the following impact on me and my children: [IMPACT ON YOU AND ANY CHILDREN] 5. **Most recent incident.** The most recent incident occurred on [DATE OF MOST RECENT INCIDENT]: [DESCRIPTION OF MOST RECENT INCIDENT] 6. **Why I believe I remain at risk.** [WHY YOU BELIEVE YOU REMAIN AT RISK] 7. **Children.** [ANY CHILDREN INVOLVED AND HOW THEY ARE AFFECTED] 8. **What I am asking for.** I ask the Court to make a non-molestation order in the terms set out in the application, prohibiting the Respondent from: (a) using or threatening violence against me or any relevant child; (b) intimidating, harassing, or pestering me or any relevant child; (c) contacting me directly or indirectly, including by telephone, text message, social media, or through third parties; (d) approaching within [EXCLUSION DISTANCE (METRES)] metres of [ADDRESSES TO BE PROTECTED]. 9. I am / am not asking for the order to be made without notice to the Respondent because [REASON FOR WITHOUT-NOTICE APPLICATION (IF APPLICABLE)]. --- **STATEMENT OF TRUTH** I believe that the facts stated in this witness statement are true. I understand that proceedings for contempt of court may be brought against anyone who makes, or causes to be made, a false statement in a document verified by a statement of truth without an honest belief in its truth. Signed: ___________________________ Name: [YOUR FULL NAME (APPLICANT)] Date: [DATE SIGNED]
Unfilled fields appear as [FIELD NAME]. Review the letter carefully before sending. This template is a starting point — adapt it to your specific circumstances.