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Hed instructions prior to filling out this form. For office use only Case number: Date filed: Registry: PART A Matter details Case number: Details of Application you seek to withdraw: PART B Applicant s details Applicant details: (for multiple applicants attach details on a separate sheet) Name Address Postcode Contacts ( ) Preferred phone number ( ) Alternative number Email NOTICE TO RESPONDENT Take note that the applicant is withdrawing the application noted in Part A of.

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