Notice to withdraw infringement notice
Schedule 3 Notice to withdraw infringement notice
[r. 15D(8)(b)]
[Heading inserted: Gazette 10 Jan 2017 p. 210.]
Health (Miscellaneous Provisions) Act 1911 WITHDRAWAL OF INFRINGEMENT NOTICE | Infringement notice no. | ||
Alleged offender | Name | ||
Address | |||
Details of infringement notice | Infringement notice no. | ||
Date of issue | |||
Details of alleged offence | Date or period | ||
Place | |||
Written law contravened | Health (Asbestos) Regulations 1992 regulation | ||
Details of offence | |||
Approved Officer withdrawing notice | Name | ||
Office | |||
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of infringement notice | The above infringement notice issued against you for the above alleged offence has been withdrawn.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. | ||
[*Delete whichever is not applicable] | * Your refund is enclosed or * If you have paid the modified penalty but a refund is not enclosed, you may claim your refund by signing and dating this notice and posting it to: | ||
Approved Officer — Health (Asbestos) Regulations 1992 [Address] Your signature Date | |||
[Schedule 3 inserted: Gazette 10 Jan 2017 p. 210‑11.]
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