Forms
Schedule 2 Forms
[r. 4]
Form 1 — Infringement notice
Gas Standards Act 1972 Infringement notice | Infringement | |
Alleged offender | Name: Family name | |
Given names | ||
or Company name ______________________________________ ACN | ||
Address __________________________________________________ Postcode | ||
Alleged offence | Description of offence ______________________________________ | |
Gas Standards Act 1972 s. Gas Standards (Gasfitting and Consumer Gas Installations) Regulations 1999 r. Gas Standards (Gas Supply and System Safety) Regulations 2000 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 ‘Director of Energy Safety’) to: Director of Energy Safety [Address] | ||
In person: Pay the cashier at: Energy Safety [Address] | ||
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 Director of Energy Safety at the above address. | ||
If you want this matter to be dealt with by prosecution in court, tick this box ❑ and post this notice to the Director of Energy Safety at the above address within 28 days after the date of this notice. | ||
[Form 1 amended: Gazette 20 Aug 2013 p. 3834; SL 2020/163 r. 32.]
Form 2 — Withdrawal of infringement notice
Gas Standards Act 1972 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 _______________________________________ | |
Gas Standards Act 1972 s. Gas Standards (Gasfitting and Consumer Gas Installations) Regulations 1999 r. Gas Standards (Gas Supply and System Safety) Regulations 2000 r. | ||
Date / /20 Time a.m./p.m. | ||
Officer withdrawing notice | Name | |
Signature | ||
Office | ||
Date | Date of withdrawal / /20 | |
Withdrawal of infringement notice | 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. | |
[*delete | * 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: Director of Energy Safety [Address] Signature / /20 | |
The statute text is free to read above. View Pro plans to unlock the case-law research tools for each provision.