Petition for Order of Reception of Mentally ill Person

To
The Metropolitan Magistrate/ Sub-divisional Magistrate/ Magistrate empowered under Act 14 of 1987
In the matter of AB of..................etc., a person alleged to be a mentally ill person under s. 2(m) of the Mental Health Act 1987 The petition of CD (full name, address and relationship) as follows: 1.I, the applicant, an................. years of age.
2.I desire to obtain an order for the reception of AB of, etc., as a mentally ill person in the Psychiatric Hospital/Nursing home at etc. etc.
3.I last saw AB at, etc., on the......................... day of....................
4.I am the..............(relationship) of the said AB.
The circumstances under which this petition is presented by the applicant are as follows, etc.
(Or, if the applicant is not a relative—That the applicant is not a relative of the said AB. The reasons why this petition is not presented by a relative are as follows, etc.)
5. The persons signing the medical certificates which accompany the application are, etc.
6. A statement of particulars relating to the said AB accompanies this petition.
7. An application for an enquiry into the mental capacity of the said AB was made to the, etc., on the...............day of..............., and a certified copy of the order made on the said application is annexed hereto.
(Or—No application for an enquiry into the mental capacity of the said AB has been made previous to this application).
I therefore pray that a reception order may be made in accordance with the foregoing statement.

(Date)