APPLICATION TO VARY CONDITIONS OF BAIL AGREEMENT or TO REVOKE BAIL AGREEMENT Bail Act 1985 (section 6(4)) PART A: APPLICATION	Court Use Date filed:
DEFENDANT DETAILS:
(Insert full name of person released on bail)
of
(insert address)
Phone No
Email Address: Alternate Phone No
☐ is charged with / ☐ has been convicted of:
(insert charge/s)
and was granted bail on / / Is this Home Detention Bail?: ☐ Yes ☐ No
Is there a guarantor? ☐ Yes ☐ No Does the guarantor consent to this application? ☐ Yes ☐ No
APPLICANT DETAILS:
I,
(Insert applicant’s name)
Of
(insert address)
apply to the Magistrates Court of South Australia, at: to
(insert sitting location)
☐ Vary the conditions of the bail agreement OR ☐ Revoke the bail agreement (mark appropriate)
I MAKE THIS APPLICATION ON THE FOLLOWING GROUNDS: Details of Variation Sought:
☐ Application to vary bail address: Date you propose to live at new address: / /
Proposed new address:
Name of Landlord: Phone No:
Reason for changing address:
☐ Application for permission to travel: ☐ within Australia OR ☐ overseas
Dates of proposed travel:
Destination:
Purpose of Travel:
☐ Application to vary any other bail condition on the following grounds:
Grounds for Application to Revoke Bail Agreement:

Applicant’s signature: ________________________________________________ Date: / /

PART B: NOTICE OF HEARING

TO –

☐ The person on bail

☐ The police prosecutor at (insert location)

☐ The Director of Public Prosecutions

☐ The guarantor of bail

The application to –

☐ Vary the conditions of a bail agreement

☐ Revoke the bail agreement

the details of which are set out in Part A, has been listed for hearing

At
(insert name of court)
On
(insert day and date)
At	☐ am ☐ pm
(insert time)

All parties to the application must attend the hearing

Court Officer’s Signature:
Date	/ /