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Schedule 5

Notice to withdraw infringement notice

In force

Schedule 5 Notice to withdraw infringement notice

[r. 54(2)]

Food Act 2008 s. 126(7) and Food Regulations 2009 r. 54(2)

Withdrawal of infringement notice

Notice No.

Alleged offender

Family name or
body corporate name and ACN

Other names

Address

No.

Street name

Postcode

Infringement notice

Infringement notice No.

Date of issue

Alleged offence

[*delete whichever
is not applicable]

Description of offence ___________________________________

*Food Act 2008 s. ________

*Food Regulations 2009 r. _________

Designated officer withdrawing notice

Name and title of officer and
name of enforcement agency

Signature

Date of notice

Withdrawal of infringement notice

[*delete whichever
is not applicable]

The above infringement notice issued against you has been withdrawn.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 [details of relevant enforcement agency].

Signature

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