Court · Magistrates' Court of Victoria · Victoria

Minutes of proposed consent orders (Form PSIO5)

Form PSIO5 records the minutes of proposed consent orders in a Victorian personal safety intervention order case. Lawyers or police complete it for the Magistrates' Court.

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Word document from Magistrates' Court of Victoria's website.

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Format
Word (DOCX)
Category
Court form
Form number
Form PSIO5
Version
ve3739691
Last verified
31 August 2026

Magistrates' Court of Victoria · Personal Safety Intervention Orders Act 2010

Preview of the first page of Minutes of proposed consent orders (Form PSIO5)
Preview - first page of the form

For law practices: this form maps to the published matter-field vocabulary, so your practice management system fills it from your matter data - on your own machine. Practice management systems can fetch and assemble it through the document assembly API.

What Form PSIO5 is for

Under section 64 of the Personal Safety Intervention Orders Act 2010 (Vic), if the parties to a proceeding for a final order consent to, or do not oppose, the order, the court may make it without being satisfied of the usual grounds in section 61 and whether or not the respondent admits the allegations (s 64(1)). The court may still refuse: for an adult respondent, if it is not appropriate having regard to s 61(2), and in any case if the order may pose a risk to the safety of a party or a child of the protected person or respondent (s 64(2)(b), (5)). If the respondent is a child, the court must still be satisfied of the s 61 matters (s 64(2)(a)). Form PSIO5 writes down the orders the parties propose so the court can consider them. The court's form page says it is for legal representatives, and police where applicable, to notify the court of a proposed resolution.

When you need it

  • The applicant (or police), the affected person and the respondent have agreed on the terms of an interim or final personal safety intervention order.
  • The respondent agrees to the order without admitting what is said in the application. The court's guide calls this consent without admission.
  • The parties are legally represented, or the police are the applicant, as the form is designed for lawyers and police representatives.

How to fill it in

  1. 1

    Court and parties

    Insert the court venue and case number, then the applicant, affected person and respondent and each one's lawyer or police representative.

  2. 2

    Children

    List any children to be included as protected persons, with sex and date of birth. Attach a page if there are more.

  3. 3

    Type of order and basis

    Tick interim or final, and whether it is by consent or by consent without admission.

  4. 4

    Duration

    For an interim order, it lasts until a final order is served on the respondent. For a final order, insert the end date and any submissions on duration.

  5. 5

    Conditions

    Tick the conditions the respondent is prohibited from, such as stalking, prohibited behaviour, contact, publishing material online or approaching within a set distance, and fill in distances and places. Note the standard exception allowing communication through a lawyer or mediator.

  6. 6

    Firearms, weapons and other terms

    Tick any agreed suspension or cancellation of firearms or weapons authorities and add any other agreed terms. Each party or their lawyer signs and dates; police sign the declaration if they obtained the affected person's oral consent to sign for them.

Filing, lodging and service

  • Give the signed minutes to the court for the hearing so the magistrate can consider the proposed orders. The form notes that final determination is a decision for the court.
  • Parties must tell the court of any change of address, as the form states.
  • On the form, an interim order is proposed to last until a final order is served on the respondent.

Common mistakes

  • On duration, the court must take into account the applicant's assessment of the level and duration of the risk and, if different, the protected person's views (s 77(2)), and may consider the respondent's matters (s 77(3)).
  • If the respondent is a child, a final order must not be for more than 12 months unless there are exceptional circumstances (s 78).
  • Consider conditions that do not prevent mediation, which the court must consider when deciding conditions (s 66).

Frequently Asked Questions

What does consent without admission mean in a personal safety intervention order?

The respondent agrees to the order being made but does not agree with what is said in the application. The court can make the order whether or not the respondent admits the particulars (s 64(1)(b)).

Can the magistrate refuse consent orders?

Yes. The court may refuse an order the parties agree to if it believes the order may pose a risk to the safety of a party or a child of the protected person or respondent (s 64(5)), and for an adult respondent if it is not appropriate in all the circumstances (s 64(2)(b)).

Checked against the official sources on 26 October 2026

General information about the form, not legal advice about your matter. Rules and forms change: if anything here differs from the court or agency's current instructions, theirs apply.

Field map

2 boxes on the Minutes of proposed consent orders (Form PSIO5) fill from your matter. 2 are for you to complete: ticks, signatures and anything that needs judgement.

Client
Client full name(s)
Operator
Operator signature (image)

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