Application for a protection order in a family violence situation Quebec
Updated on
Free template to adapt to your situation: replace the sample information (names, addresses, dates, amounts, references) with your own.
FreeTemplate letterWord · PDF · No sign-up
DownloadWord or PDF
If you are in immediate danger, call 911. SOS violence conjugale (24/7): 1-800-363-9010. This document helps you prepare your application with a lawyer or the court registry.
Application for a Protection Order – Family Violence
Applicant: [first and last name], [confidential address if needed], [phone].
Respondent: [first and last name], [relationship: spouse, former spouse, parent, child].
Children concerned: [first names, ages].
1. Acts of violence
- [Date, place: precise description of the physical, psychological, verbal, sexual or economic violence, threats or coercive control.]
- [Date, place: ___.]
Police complaint(s): [no. ___ of ___ / none]. Existing conditions or orders: [___].
2. Risk
[Explain why your safety, or that of your children, remains threatened: access to weapons, escalation, separation, threats to kill, etc.]
3. Orders sought
- prohibition from contacting me and the children, directly or indirectly, by any means;
- prohibition from being within [___] metres of my residence, workplace and the children’s school;
- [provisional exclusive use of the family residence / provisional custody of the children];
- for a duration of [___].
4. Evidence
[Messages, photos, medical reports, police reports, witnesses.]
Sworn before me at [city], on [date]. Applicant: ____________ Commissioner for oaths: ____________
Free, no sign-up. Replace the sample information with your own.
DownloadWord or PDF
Drafting notes
- The civil protection order (Code of Civil Procedure) may be issued by the Superior Court, ex parte in urgent cases, where a person’s life, health or safety is threatened.
- Since the 2024 reforms, courts must consider family violence, including coercive control, in determining the child’s interest; coercive control is also a criminal offence under the Criminal Code.
- Specialized domestic violence courts and free legal aid may be available.
How to use this template
- Download the letter in Word or PDF with the button above.
- Adapt it to your situation: your contact information, the recipient’s, the facts, dates and amounts.
- Send it and keep a dated copy.
About the author
Sonia Pin Legal counsel, business law
Sonia Pin is a legal professional specializing in business law and commercial litigation. She drafts and updates the contract and letter templates published on Avocat Montréal, with a focus on Quebec civil law (Civil Code of Québec) and the practical requirements of the courts and administrative tribunals.
