Intimate

Relationship
Questionnaire
Summary of the Domestic Violence Act, 1998
Application Form for a Protection Order.

Intimate Relationship Questionaire 1

 TABLE OF CONTENTS
PART A: Relevant questions about your intimate relationship
PART B: Summary of the Domestic Violence Act 1998 (ACT 116
of 1998)

PART A: How to obtain a protection order

1. What is a protection order? 12

2. What is domestic violence? 12
3. Who can apply for a protection order 12
4. Jurisdiction – where can the application be made? 13
5. When may the application be made (s 4(5)? 13
6. The procedure of obtaining the protection order 14
7. The protection order is enforceable nationwide- s12 (3) 21
8. What must the complainant do. 12
9. Arrest of respondent for violation of protection order 21
10. Variation of the order 21

PART B: Prosecution for violation of protection order

1. The Charge 22
2. The Withdrawal restriction on violation of protection 22
order- s18

3. Proceedings under this Act may be held in 22

camera- s 11(1)

4. Offences- s17 24
5. Penalties – s 17 25

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4 Intimate Relationship Questionaire
HOW IS YOUR RELATIONSHIP WITH YOUR
INTIMATE PARTNER?
Sometimes parties in an intimate relationship are not aware that their
behavior is abusive or are being abused by their partners. Please
take this opportunity to assess if you are abused or an abuser in your
intimate relationship.

1. Do you find that your partner often prevents you from seeing
friends or participate in activities that do not include him / her?
Yes No

Do you find that you often stop your partner from seeing his /her
friends or participate in activities that do not include you?
Yes No

2. Does your partner frequently check your whereabouts when he/

she is not with you?
Yes No

Do you frequently check the whereabouts of your partner

whenever you are not with him/her?
Yes No

3. Are you scared of receiving phone calls from the opposite sex in
the presence of your partner?
Yes No

Are you suspicious when your partner receives phone calls from
the opposite sex in your presence?
Yes No

4. Do you feel pressured to explain to your partner each time you

receive a phone call from an opposite sex?
Yes No

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 Do you demand an explanation from your partner each time he/
she receives a phone call from an opposite sex?
Yes No

5. Does your partner read your e-mails, smses, history of calls,

Facebook or any social media communication without your
permission?
Yes No

Do you read the e-mails, smses history of calls, Facebook/Tweeter

entries or any social media communication from the device of
your partner without his/her permission?
Yes No

6. Does your partner openly criticize the way you dress, talk or do
things?
Yes No

Do you openly criticize your partner for the way he/ she dresses,
talks or does things?
Yes No

7. Are there times when your partner teases you to deliberately

hurt your feelings?
Yes No

Are there times when you tease your partner to deliberately hurt
him/her?
Yes No

8. Does your partner make fun of you in front of family members,

friends or strangers?
Yes No

Do you make fun of your partner in front of family members,

friends or strangers?
Yes No

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9. Does your partner deliberately ignore you when he/she is with
friends or family members?
Yes No

Do you deliberately ignore your partner when you are with your
friends or family members?
Yes No

10. Does your partner usually decide what you do during your time
together?
Yes No

Do you usually impose your decision on your partner on how you

should spend your time together?
Yes No

11. Do you often feel pressured to do something you do not approve

of?
Yes No

Do you often pressurize your partner to do something he/she

does not approve of?
Yes No

12. Has your partner ever hit you or threatened to hit you?
Yes No

Have you ever assaulted or threatened to assault your partner?

Yes No

13. Do you feel scared to say, ‘NO’ to your partner without giving
reasons?
Yes No

Does your partner feel scared to say ‘NO’ to you without having
to explain himself/ herself?
Yes No

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 14. Does your partner force you to engage in sexual activities you
are uncomfortable with?
Yes No

Do you force your partner to engage in sexual activities that

make him/ her uncomfortable?
Yes No

15. Do you often feel pressured by your partner to have sex without
a condom or any protection?
Yes No

Do you pressurize your partner to have sex with you without a

condom or any protection?
Yes No

16. Does your partner exchange favours for sex?

Yes No

Do you make your partner to have sex with you in exchange for
favours?
Yes No

17. Does your partner make you feel bad about yourself?
Yes No

Do you make your partner feel bad about himself / herself?

Yes No

18. Are you afraid to express your views to your partner?

Yes No

Do you make your partner scared to express himself / herself

freely to you?
Yes No

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19. Does your partner often compare you with his/her previous
intimate partner to hurt you?
Yes No

Do you often compare your partner with your previous intimate

partner to hurt him/her?
Yes No

20. Does your partner often invite you to an outing, and then expect
you to foot the bill?
Yes No

Do you often invite your partner to an outing and expect him /

her to foot bill?
Yes No
21. Do you often feel compelled to pay your partner’s debts or
expenses?
Yes No

Do you often compel your partner to pay your debts or expenses?

Yes No

22. Are you often forced to get your partner’s permission to do a

paid job?
Yes No

Do you often force your partner to get your permission before

taking on a job for an income.
Yes No

23. Has your partner ever disposed of shared goods or property

without involving you?
Yes No

Do you feel entitled to dispose of shared goods or property

without involving your partner?
Yes No

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 24. Does your partner often threaten to end the relationship if you
don’t submit to his / her demands?
Yes No

Do you threaten to end the relationship if your partner does not

do what you want/ demand?
Yes No

25. Does your partner make you feel unsafe in this relationship?
Yes No

Do you make your partner feel unsafe in this relationship?

Yes No

If you have ticked ‘YES’ in any of the questions, you

should be concerned as you are likely a victim or an
abuser in your relationship.

If you are an abused partner, please read on to learn about

your rights and how to exercise them.

Quickly go the nearest magistrate’s court to apply for a

protection order and/ or lay a criminal charge with the
police.

Application Form for a Protection Order

(Form 2).

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 PART B
Summary of the Domestic Violence
Act, 1998 (ACT 116 of 1998)

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 PART A: HOW TO OBTAIN A PROTECTION ORDER?

1. WHAT IS A PROTECTION ORDER?

It is a written order that is issued by the magistrate’s or family
court to stop any person from committing any act of domestic
violence against another person with whom he or she has a
domestic relationship.

2. WHAT IS DOMESTIC VIOLENCE?

Domestic violence refers to forms of abuse which include physical
abuse; emotional, verbal and psychological abuse; economic
abuse; intimidation; harassment; stalking; damage to property;
etc. The Act further gives an overarching ‘catch all’ definition of
domestic violence that any abusive or controlling behaviour that
threatens the health, safety and well-being of the complainant
also amounts to domestic violence.

FORMS OF ABUSE IN TERMS OF THE DOMESTIC

VIOLENCE ACT

Physical Abuse may include:

• Shoving, slapping, punching, kicking, throttling, biting
• Assault with objects, guns, knives or any other dangerous
weapon

Sexual Abuse may include:

• Rape, attempted rape, indecent assault
• On-going verbal abuse with sexual slurs such as bitch, whore,
slut, etc.

Emotional, Verbal and Psychological Abuse may include:

• Constant insults, ridicule or name calling
• Repeated threats of violence or death to cause emotional
pain

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Economic Abuse may include:
• Selling of shared property e.g. livestock, matrimonial
house without the consent of the victim
• Accessing a joint bank account for personal use without
the consent of the victim

Intimidation could be:

• Sending written or verbal death threats to the victim
• Sending beheaded dolls, small coffins, dead flowers or
dead pets to the victim

Harassment may include:

• Repeatedly watching the victim outside or near her house,
workplace, school or business premises or any place where
she happens to be
• Repeatedly phoning the victim or causing any other per-
son to phone her whether or not the caller speaks to the
complainant

Stalking means, for example:

• Constantly approaching the victim and asking or demand-
ing to talk to her against her will

Damage to Property may include acts of:

• Breaking the window to gain entry into the victim’s house
• Cutting, breaking or damaging in any other manner
shared furniture

Unauthorised Entry into the Victim’s Residence may include:

• Using a duplicate key to gain access may also constitute
domestic violence

Both men and women can be guilty of, and be victims of do-
mestic violence.

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3. WHO CAN APPLY FOR A PROTECTION ORDER?
§ The person who seeks the Order is referred to as the
complainant.
§ The person who has or allegedly committed an act of
domestic violence and against whom the Order is applied is
for called the respondent.

3.1. The requirement of a Domestic Relationship

The complainant of domestic violence must be or must have
been involved in a domestic relationship with the respondent
to qualify for a protection order. A domestic relationship is
defined in s 1 (vii) of the Act.

3.2. Persons who can apply for a Protection Order- s4

§ The victim of domestic violence,
§ Any minor without the assistance of a parent, guardian or
any other person (s 4(4),
§ Any person on behalf of the minor without the assistance
of the minor’s parent, guardian or any other person (s
4(4),
§ Any person on behalf of the complainant who has a
material interest in the well-being of the complaint,
including counsellors, health workers, police, social
workers or teachers. The written consent of the
complainant is required, unless the complainant is a
minor, mentally retarded, unconscious or is found by the
court to be unable to give such consent (s 4(3)).

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 4. JURISDICTION – where can the application be made?
At the magistrate’s court / family court situated within: -
§ The area of the complainant’s residence or employment or
where he or she carries business – whether permanently or
temporarily, or
§ The area in which the respondent stays, works or carries
business, or
§ The area where the act of domestic violence was committed.

5. WHEN MAY THE APPLICATION BE MADE (s 4(5))?

§ During the ordinary court hours and days.
§ Outside ordinary court hours, during weekends or public
holidays and when the court is satisfied that the complainant
may suffer undue hardship if the application is not dealt
with immediately (s 4(5). e.g. where the respondent used
or is threatening to use a dangerous weapon against the
complainant.
However, please note that not all courts are providing services
after court hours/ days yet, mostly due to inadequate resources.

6. THE PROCEDURE OF OBTAINING THE PROTECTION

ORDER

6.1. The complainant must visit the office of the clerk of

the court immediately after the act of domestic
violence is committed.

6.2. The Complainant must be informed of his/her rights

that he/she has:
§ The right to apply for a protection order,
§ The right to also lay a criminal charge if the respondent’s act
of domestic violence also constitutes a crime, e.g. where the
complainant was physically/ sexually abused (s 4(2),

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 These rights must be communicated to the complainant in the
language in which the complainant best understands:
»» By the Police, i.e. where the report is made to them, and
when it is reasonably possible to do so (s 2 (c ). In doing so,
the police uses the prescribed Form 1 or
»» By the clerk of the court, i.e. if the complainant is not legally
represented (s4 (2). In this instance, the clerk will use the
prescribed Form 3.

6.2.1. Possible Prohibitions of the Protection Order- s 7(1);

Form 3
The Protection Order may prohibit the respondent from:
§ Committing any specified act of domestic violence;
§ Obtaining assistance from another person to commit any act
of domestic violence;
§ Entering the shared residence, if it appears to be in the
interests of the complainant to do so. If necessary, the
respondent may be further ordered to pay or continue to pay
rent or mortgage bond attached to the shared residence (s7
(3);
§ Entering any specified part of the shared residence, e.g.
complainant’s bedroom;
§ Entering the complainant’s residence (where parties are not
staying together);
§ Entering the complainant’s work place;
§ Preventing the complainant or any child who normally lives
in the shared residence from entering or remaining in such
residence or any part thereof; and
§ Committing any other act determined by the court.

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6.2.2. Additional Conditions- (s 7(2)
To protect and provide for the safety, health or well being of the
complainant, the court may, if it deems reasonably necessary,
impose on the respondent additional conditions, which may
include an order:
§ That a police officer accompanies complainant to a specified
place to assist with arrangements regarding the collection
of complainant’s personal belongings, i.e. in cases where
resistance of further violence is anticipated (s 7(2) (b);
Personal belongings are items that are exclusively used by
complainant or any other person.
§ That arms or dangerous weapon(s) in the possession or
control of the respondent be seized (s 7(2) (a);
§ That respondent pays or contributes towards payment of rent
or mortgage, if parties are or were sharing a house (s 7(3);
§ That respondent pays emergency monetary relief, which
relates to the monetary losses suffered by the complainant at
the time of the issue of the protection order, such
»» Loss of earnings;
»» Medical and dental expenses;
»» Relocation and accommodation expenses, or household
necessities (s 7(4).
§ That respondent contributes towards the maintenance of
children. This condition will be valid until such time that the
complainant is granted with the Maintenance Order by the
maintenance court upon application.
§ That the physical address of the complainant not be disclosed
to the respondent (s 7(5);
§ That the respondent be refused contact with any of the
parties’ child, if that will be in the interest of such child
(s 7 (6)).

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 6.3. Application for the Protection Order by the complainant – s4(1)
The complainant must make her application by completing the
prescribed affidavit (Form 2) with the assistance of the Clerk of
the court, if necessary. Refer to Part C of this booklet.

6.4. Supporting Affidavits to accompany the complainant’s

application- s 4(6)
Affidavits of eyewitnesses or other persons who have the relevant
knowledge or information regarding the alleged incident of
domestic violence may be obtained to support the complainant’s
application, e.g. medical report confirming the injuries sustained.

6.5. Submission of the Application to court for consideration by the

Clerk of the court- s4 (7)
As soon as all the necessary information is obtained, the clerk of
the court must immediately submit complainant’s affidavit and
accompanying information (if any) to court for consideration.

6.6. Consideration of the Application by the court

6.6.2. When the Application is for the Interim Protection
Order – s5
The court:
»» May call additional evidence, e.g. evidence of eye witness
»» Must grant the interim protection order if it is satisfied that:
§ The respondent has committed an act of domestic violence,
and
»» The complainant may suffer undue hardship from the
alleged domestic violence if the protection order is not
issued immediately.

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 The respondent must be served with the Interim Protection
Order accompanied by complainant’s application and
supporting affidavits (if any)- s 5(3) by:
»» Clerk of the court,
»» Sheriff,
»» Peace officer, or
»» Any person so directed by the court (s13 (1).

Where the complainant cannot afford to pay for the service

fees – s13(2)
»» The State is required to provide her with the required financial
assistance.
* Upon service of the Interim Protection Order on the
respondent
»» The complainant must be served with the certified copy of
the Interim Protection order and the suspended original
warrant for the arrest of the respondent upon violation of
such order- s 5(7).

6.6.2. When NO Interim Protection Order is issued- s5 (4)

Where the court is satisfied that the respondent has committed an
act of domestic violence against the complainant, but is not satisfied
that the complainant would suffer undue hardship if the order is not
made immediately:
»» The respondent must be served with the Notice (Form 5)
calling upon him to show as to why the protection order
should not be granted against him.
»» The Notice must be accompanied by the complainant’s
application and the supporting affidavits, if any.

6.6.3 The Return Date – s 5(5)

»» May not be less than 10 days after the respondent has
been served with the documents. This is to ensure that

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 the respondent is given reasonable time to respond to the
complainant’s allegations.

6.6.4 Upon consideration of the complainant’s application

on the return date, the court must do either of the
following: -
a. When the respondent fails to appear in court- s 6(1)
• The court must grant the final order, if it is satisfied that:
»» There was proper service on the respondent, and
»» There is prima facie evidence i.e. information to the effect
that it is likely that the respondent has committed the alleged
act of domestic violence.

b. When the respondent opposes the application –s 6(2)

»» The court must consider the evidence on the balance of
probabilities, and thereafter grants or refuses the application,
as it deems appropriate.
»» Where it is satisfied that respondent has committed or
is committing an act of domestic violence against the
complainant, the court must issue a protection order.

6.6.5 When the court issues the Protection Order and a

stayed Warrant of Arrest
»» The original Protection Order must be immediately served on
the respondent (s 6 (5) (a),
»» A certified copy of the Protection Order and the original
warrant for the arrest of the respondent must be immediately
served on the complainant, and
»» Certified copies of the Protection Order and warrant of
arrest must be forwarded to the police station chosen by the

Intimate Relationship Questionaire 23

 complainant (s 6(7).

7. THE PROTECTION ORDER IS ENFORCEABLE NATIONWIDE-

S12 (3)
»» The Protection Order is enforceable at any magistrate’s /
family court in SA. This means that a court in Cape Town will
have jurisdiction to try an offence of a Violation of a Protection
Order that was issued by a court in Pretoria. In terms of this
provision, the complainant is afforded with meaningful,
immediate and all-round protection.

8. UPON VIOLATION OF THE PROTECTION ORDER, THE

COMPLAINANT MUST:
»» Immediately report such violation to the nearest police
station.
»» Hand to the police the certified copy of the Protection Order
and the original warrant of arrest for execution.
»» Make an affidavit stating in detail the manner in which the
alleged violation occurred (Form 10)

9. ARREST OF RESPONDENT FOR VIOLATION OF

PROTECTION ORDER
Where the respondent reports an alleged violation of the
protection order to the police, the police official must arrest the
respondent if there is a reasonable suspicion that the respondent
has breached the order and that the complainant will be subjected
to imminent/immediate harm as a result of such breach.

If the respondent is not arrested –

The police must issue the respondent with a notice to appear in
court (Form 11) on a charge of violating the protection order.

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 10. VARIATION OF THE ORDER
The complainant or respondent may make an application for
variation or amendment setting aside of the order (Form 12).

Before setting aside the order, the court must be satisfied, where
an order for setting aside is made by the complainant that the
complainant is doing so freely and voluntarily.

PART B: PROSECUTION FOR VIOLATION OF

PROTECTION ORDER

1. The Charge
§ The violation of protection order is a serious crime that is
punishable in law.
2. The Withdrawal restriction on violation of protection order- s18
§ Prosecutors are not allowed to withdraw any criminal
charge of violation of the protection order (s17 (a)) without
the authority of the Director of Public Prosecutions or any
designee.
3. Proceedings under this Act may be held in private- s 11(1)
§ Persons who may be present in court are: -
»» Officers of the court, i.e. magistrate, prosecutor,
interpreter, intermediary (in the case involving children),
etc.
»» The parties to the proceedings,
»» Legal representative,
»» Not more than 3 support persons for the complainant,
»» Not more than 3 support persons for the accused, and
»» Any other person whom the court may permit his / her
presence.

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4. Any Child Witness
§ May testify in camera (i.e. private) with the assistance of an
intermediary in terms of s170 A of the Criminal Procedure
Act, 1977 (Act No 51 of 1977)

5. Any Other Witness

§ May testify in camera (i.e. private) by means of closed circuit
television or any similar electronic media, especialy when
such witness is traumatised.

6. Offences- s17
In terms of the Act the following conduct constitutes crime: -
§ The violation of any prohibition, condition or order imposed
by the Protection Order,
§ The publication in any manner of information, which might
directly or indirectly reveal the identity of any party to the
proceedings, i.e. of complainant/respondent;
§ Failure to comply with any direction given by the court in
terms of s 12(2)(b) regarding the prohibition of publication of
any further information relating to the proceedings,
§ The willful making of a false statement in respect of a
material aspect in an affidavit by the complainant at the time
he / she reports any violation of the protection order by the
respondent.

7. Penalties – s 17
For offences 1 and 2 above, the respondent may be sentenced to
pay a fine or undergo imprisonment for a period not exceeding
five (5) years or to both such fine and imprisonment.
For offences 3 and 4 above, the respondent is liable on conviction
to a fine or imprisonment for a period not exceeding three (3)
years or to both such fine and imprisonment.

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 PART C: APPLICATION FORM (FORM 2)

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Notes

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 Chief Directorate: Promotion of the Rights of Vulnerable Groups
Department of Justice and Constitutional Development:
Momentum Centre: 329 Pretorius Street (c/o Pretorius & Sisulu St), Pretoria, Private Bag X81,
Pretoria, 0001, Tel: 012 315 1111 / www.justice.gov.za
SALU Building: 316 Andries* Street (c/o Thabo Sehume & Francis Baard Streets) Pretoria, Tel: 012 406 4600

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