Forms
Schedule 2 Forms
[r. 19]
[Heading inserted: Gazette 22 Sep 2006 p. 4080.]
Form 1 — Infringement notice
Charitable Collections Act 1946 Infringement notice | Infringement | |
Alleged offender | Name: Family name | |
Given names | ||
or Company name ____________________________________ ACN | ||
Address ________________________________________________ Postcode | ||
Alleged offence | Description of offence _____________________________________ | |
Charitable Collections Act 1946 s. Charitable Collections Regulations 1947 r. | ||
Date / 20 Time a.m./p.m. | ||
Modified penalty $ | ||
Officer issuing notice | Name | |
Signature | ||
Office | ||
Date | Date of notice / /20 | |
Notice to alleged offender | 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 within 28 days after the date of this notice. How to pay By post: Send a cheque or money order (payable to ‘Approved Officer — Charitable Collections Act 1946’) to: Approved Officer — Charitable Collections Act 1946 Department of Local Government, Industry Regulation and Safety Locked Bag 14 Cloisters Square Perth WA 6850 In person: Pay the cashier at the Cannington office, or any regional office, of the Department of Local Government, Industry Regulation and Safety ____________________________________________ 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 can apply for an extension of time by writing to the Approved Officer at the above postal address. If you want this matter to be dealt with by prosecution in court, sign here ______________________________________________ | |
[Form 1 inserted: Gazette 22 Sep 2006 p. 4080; amended: Gazette 20 Aug 2013 p. 3824; SL 2020/120 r. 12; SL 2020/163 r. 14; SL 2026/153 r. 14(1).]
Form 2 — Withdrawal of infringement notice
Charitable Collections Act 1946 Withdrawal of infringement notice | Withdrawal no. | |
Alleged offender | Name: Family name | |
Given names | ||
or Company name _____________________________________ ACN | ||
Address _________________________________________________ Postcode | ||
Infringement notice | Infringement notice no. | |
Date of issue / /20 | ||
Alleged offence | Description of offence ____________________________________ | |
Charitable Collections Act 1946 s. Charitable Collections Regulations 1947 r. | ||
Date / /20 Time a.m./p.m. | ||
Officer withdrawing notice | Name | |
Signature | ||
Office | ||
Date | Date of withdrawal / /20 | |
Withdrawal of infringement notice [*delete | The above infringement notice issued against you 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, to claim your refund sign this notice and post it to: Approved Officer — Charitable Collections Act 1946 Department of Local Government, Industry Regulation and Safety Locked Bag 14 Cloisters Square Perth WA 6850 Signature / /20 | |
[Form 2 inserted: Gazette 22 Sep 2006 p. 4081; amended: SL 2020/120 r. 12; SL 2026/153 r. 14(2).]
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