IN THE COURT OF __________COURT, ______________

AT _____________
CASE NO: - _________________
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V/s

APPLICATION FOR__________________

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MAY IT PLEASE YOUR HONOUR:

It is most respectfully submitted on behalf of the ________________

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FOR THIS ACT OF KINDNESS, THE PARTY IS DUTY BOUND

FOREVER.

Place: - ____________
Date: - ____________

Advocate for __________________