Schedule 6

Forms

Current

[r. 36C]

[Heading inserted: Gazette 26 Apr 2019 p. 1219.]

Form 1 — Infringement notice

Building Services (Registration) Act 2011 INFRINGEMENT NOTICE				Infringement notice no.
Alleged offender	Name

	Address

Alleged offence	Date or period
	Time
	Place
	Details of offence

	Written law contravened

Date	Date of notice
Issuing officer	Name
	Office
	Signature
Modified penalty	$
TAKE NOTICE	It is alleged that you have committed the above offence. If you do not want to be prosecuted in court for the offence, pay the modified penalty to the Approved Officer within 28 days after the date of this notice.
	If you do not pay the modified penalty within 28 days, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994. Under that Act, some or all of the following action may be taken — your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold. If you need more time to pay the modified penalty, you should contact the Approved Officer at the address below. Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case. If you want this matter to be dealt with by prosecution in court, sign and date here: __________________________________ / /20 and post this notice to the Approved Officer at the address below within 28 days after the date of this notice.
How to pay	By post	Tick the relevant box below and post this notice to: Approved Officer — Building Services (Registration) Act 2011 [Address] I want to pay the modified penalty. A cheque or money order (payable to ‘Approved Officer’ — Building Services (Registration) Act 2011) for the modified penalty is enclosed. I want to pay the modified penalty by credit card. Please debit my credit card account.
		Card type _____________________________ Cardholder name _______________________ Card number [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Expiry date of card _____/_____ Amount $__________ Signature ____________________ Complete all details
	In person	Pay the cashier at: [Address]
Method of service			Date of service

[Form 1 inserted: Gazette 26 Apr 2019 p. 1219-21.]

Form 2 — Withdrawal of infringement notice

Building Services (Registration) Act 2011 WITHDRAWAL OF INFRINGEMENT NOTICE			Withdrawal no.
Alleged offender	Name

	Address

Details of infringement notice	Infringement notice no.
	Date of issue
Alleged offence	Date or period
	Time
	Place
	Details of offence

	Written law contravened

Approved Officer withdrawing notice	Name
	Office
	Signature
Date	Date of withdrawal
Withdrawal of infringement notice [Delete whichever is not applicable]*	The above infringement notice issued against you for the above alleged offence has been withdrawn. If you have already paid the modified penalty for the alleged offence, you are entitled to a refund. * Your refund is enclosed or * If you have paid the modified penalty but a refund is not enclosed, you may claim your refund by signing and dating this notice and posting it to: Approved Officer — Building Services (Registration) Act 2011 [Address]
Your signature		Date

[Form 2 inserted: Gazette 26 Apr 2019 p. 1221-2 amended: SL 2020/163 r. 10.]

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