Forms for infringement notice and withdrawal notice

In force

[r. 9(1) and (2)]

[Heading inserted: SL 2025/35 r. 23.]

Form 1 — Infringement notice

Casino Control Act 1984 INFRINGEMENT NOTICE			Infringement notice no.
Alleged offender	Name

	Address

Alleged offence	Date or period
	Time
	Place
	Details of offence

	Written law contravened

Modified penalty	$
Date	Date of notice
Issuing officer	Name
	Signature
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 (the Gaming and Wagering Commission) within 28 days after the date of this notice. If you do not pay the modified penalty within 28 days after the date of this notice, 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 Gaming and Wagering Commission 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: __________________________________ / / and post this notice to the Gaming and Wagering Commission at the address below within 28 days after the date of this notice.
How to pay	By post	[Insert details for paying by post]
	In person	[Insert details for paying in person]
	Electronically	[Insert details for paying electronically]

[Form 1 inserted: SL 2025/35 r. 23.]

Form 2 — Withdrawal of infringement notice

Casino Control Act 1984 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

Officer of the Commission withdrawing notice	Name
	Signature
Date	Date of withdrawal
Withdrawal of infringement notice	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. [Insert details for processing of refund.]

[Form 2 inserted: SL 2025/35 r. 23.]

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