Crimes Regulations 2019

Commonwealth of Australia

Crimes Act 1914

CERTIFICATE UNDER SUBSECTION 21B(3)

IN THE ¹

AT ²

IN THE *STATE OF ³

BETWEEN:

⁴(Informant)

‑and‑

⁵(Defendant)

I, ⁶, ⁷, hereby certify that on ⁸ the court ordered that ⁹ is to pay $ ¹⁰ to ¹¹ by ¹².

Dated ¹³.

¹⁴

⁷

Note You have been convicted of a federal offence under the Crimes Act 1914 or, under section 19B of that Act, you have been discharged without conviction. The court has also ordered you to make reparation to the Commonwealth, a public authority under the Commonwealth or another person by payment of an amount of money or otherwise. This payment is in addition to any fine or other penalty imposed by the court. The above certificate when filed in a court of civil jurisdiction is enforceable as a final judgment of the court in which it is filed.

¹ insert name of court

² insert location of court

³ insert State or Territory

⁴ insert name of informant

⁵ insert name of defendant

⁶ insert full name of clerk or appropriate officer

⁷ insert designation of officer

⁸ insert date of order

⁹ insert name of defendant

¹⁰ insert amount

¹¹ insert to whom amount is to be paid

¹² insert date by which amount is to be paid

¹³ insert date

¹⁴ signature of clerk or appropriate officer

* omit if inapplicable