Charge-sheet and summons
Form 3 Charge-sheet and summons
Rule 13(c)
Charge-sheet and Summons
Details of accused
Name:
Gender:
Date of birth:
Accused identifies as:
🞏 Aboriginal 🞏 Torres Strait Islander 🞏 Both 🞏 Neither
Mobile phone number:
Email address:
Registration number of vehicle: State registered:
Driver licence number: State issued:
To the accused:
You have been charged with an offence.
Read these pages to see what you must do.
Details of the charge against you
What is the charge?
[Description of offence]
| Section or Clause |
Under what law? | 🞏 State | 🞏 Act | Regulation No. | (Full Ref.) |
🞏 Commonwealth | 🞏 Regulation |
🞏 Other—specify |
Is this an infringement offence? | 🞏 Yes—see below | 🞏 No | ||
🞏 Enforcement review | 🞏 Enforcement review—special circumstances | |||
🞏 Infringements Act 2006 section 40 | 🞏 Other—specify | |||
Date of service by the Director, Fines Victoria |
Are there more charges? | 🞏 No | 🞏 Yes—see "Continuation of Charges" attached | ||
Type of offence | 🞏 Summary offence | 🞏 Indictable offence | ||
Request for committal proceeding | 🞏 No | 🞏 Yes | ||
Who filed the charge-sheet(s)?
Name of informant:
Agency and address:
Telephone:
Email:
Agency Ref.:
Signature of informant:
Date:
Filed at:
Date:
Where will the case be heard?
The Magistrates' Court at [venue]
Address Telephone
When Time Day Month Year
Details about this summons
Issued at:
Date:
Registrar:
Magistrate:
Police officer:
Prescribed person:
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