District No.

............. Applicant

and

............ Convicted Person

(child/young person)

both of .............. Injured Party of ...............

WHEREAS the above-named convicted person is a *child *young person within the meaning of the Children Acts, 1908 to 1989 and above the age of seven years, and the above-named applicant is the *parent *guardian of the said person,

AND WHEREAS on the ... day of ............. 19 ..... , on conviction of the said person of an offence, THE COURT MADE A COMPENSATION ORDER against the said *parent *guardian under section 6 (1) of the Criminal Justice Act, 1993 and section 99 of the Children Act, 1908 ordering him/her to pay the sum of £ ..... as compensation to the above-named injured party who suffered *personal injury *loss resulting from * (that offence) *(an offence taken into consideration in determining sentence), and directing that the said compensation be paid *(in one payment) *(by .................. consecutive * weekly *monthly instalments of £ each and a final balance of £ , the first of such instalments to be paid on the ... day of ........... 19 ... ,)

AND WHEREAS because of a substantial reduction in his/her means, the said * parent *guardian claims that those means are insufficient to satisfy that order in full,

TAKE NOTICE that the above-named *parent *guardian will apply at the sitting of the District Court to be held at ............ on the ...... day of ......... 19 ..... at ..... a.m./p.m. for an order under section 6 (8) (a) of the said Act of 1993—

* reducing the amount remaining to be paid

* varying (an) instalments) payable

* directing that no payments/further payments be made under the compensation order.

Dated this .... day of ......... 19 .... .

Signed .........................

Applicant/Solicitor for applicant

To

of

The above-named injured party.

*Delete words inapplicable.