Part FORM 20.10B Form of application under section 234A(6) of the Criminal Procedure (Scotland) Act 1995

UNTO THE RIGHT HONOURABLE THE LORD JUSTICE GENERAL, LORD

JUSTICE-CLERK AND LORDS COMMISSIONERS OF JUSTICIARY

[or UNTO THE HONOURABLE THE SHERIFF

OF (name of sheriffdom) AT (place)]

[or UNTO THE JUSTICES in the DISTRICT COURT

OF (name of district) AT (place)]

APPLICATION

by

Her Majesty’s Advocate [or

[A.B.] (address) [or Prisoner in the Prison of (place)]

APPLICANT

HUMBLY SHEWETH: