Forms
Schedule 2 Forms
[r. 7]
Form 1 — Infringement notice
The Criminal Code Infringement notice | Infringement | ||
Alleged offender | Name: Surname | ||
Given names | |||
Address _________________________________________________ Postcode | |||
Alleged offence | Description of offence _________________________________________________ | ||
The Criminal Code s. | |||
Date / /20 Time | |||
Place | |||
Modified penalty $ | |||
Officer issuing notice | Name | ||
Registered number | |||
Police station | |||
Date of issue | / /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 alleged offence, pay the modified penalty above to an approved officer within 28 days after the date of issue of this notice. See below for how and where to pay the modified penalty. Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case. If you do not pay the modified penalty within 28 days, you may be prosecuted in court for the alleged offence or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994 to recover the modified penalty. 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 want this matter to be dealt with by prosecution in court, sign and date here: __________________________________ / /20 If you are prosecuted in a court for the alleged offence, and convicted, you will be liable to a penalty and costs. | ||
How to pay the modified penalty | In person | [Details for paying in person] | |
By post | Post this notice, with a cheque or money order made payable to [payee], to: [Address] Do not send cash in the mail. | ||
Online | [Details for online payments] | ||
By telephone | [Details for telephone payments] | ||
[Form 1 amended: SL 2020/162 r. 6.]
Form 2 — Withdrawal of infringement notice
The Criminal Code Withdrawal of infringement notice | |
Alleged offender | Name: Surname |
Given names | |
Address _________________________________________________ Postcode | |
Infringement notice | Infringement notice no. |
Date of issue / /20 | |
Alleged offence | Description of offence _________________________________________________ |
The Criminal Code s. | |
Date / /20 Time | |
Place | |
Officer withdrawing notice | Name |
Registered number | |
Police station | |
Date of withdrawal | / /20 |
Withdrawal of infringement notice | The above infringement notice, which was issued for the above alleged offence, has been withdrawn. If you have already paid the modified penalty for the alleged offence in accordance with the infringement notice, the amount will be refunded to you. |
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