Schedule 1

Forms

Current

[r. 3, 4, 6]

[Heading inserted: Gazette 22 Sep 2006 p. 4116.]

Form 1

HIRE‑PURCHASE ACT 1959

(Section 12A)

APPLICATION BY OWNER FOR CONSENT OF COMMISSIONER TO TAKE POSSESSION OF GOODS UNDER A HIRE‑PURCHASE AGREEMENT WHEN 75% OF TOTAL AMOUNT PAYABLE HAS BEEN PAID

Commissioner for Consumer Protection,

.............................................................................

Owner’s name and address ....................................................................................

................................................................................................................................

Hirer’s name and address .......................................................................................

................................................................................................................................

Guarantor’s name and address (if applicable) .......................................................

................................................................................................................................

Short description of goods .....................................................................................

................................................................................................................................

Total Amount payable under agreement $................................................. Amount so far paid $.................................................

Instalment arrangements under agreement

No. of Instalments

Frequency

Amount of each Instalment

Number of Instalments and date of last Instalment

.................................................................................................................................

Reasons for request

.................................................................................................................................

......................................... ..................................................................

Date Signature

NOTE:

An owner aggrieved by a decision of the Commissioner not to give consent may apply to the State Administrative Tribunal for a review of the decision.

[Form 1 amended: Gazette 30 Dec 2004 p. 6922.]

Form 2

HIRE‑PURCHASE ACT 1959

(Section 36A)

APPLICATION FOR RELIEF AGAINST THE CONSEQUENCES OF BREACH OF A HIRE‑PURCHASE AGREEMENT BY REASON OF SICKNESS OR UNEMPLOYMENT

To COMMISSIONER FOR CONSUMER PROTECTION,

...............................................................................................

I/We .......................................................................................................................

(full name in block letters)

of ............................................................................................................................

(full postal address)

Telephone No. ............................... *apply for relief .............................................

.................................................................................................................................

with respect to moneys due and payable under a hire‑purchase agreement with

.................................................................................................................................

(full name and address of owner)

because of sickness/unemployment the details of which are set out hereunder.

Details of Hire‑Purchase Agreement (attach copy).

Short description of goods.....................................................................................

...............................................................................................................................

Details of instalments

Last payment made on the .................................. day of ....................................... 20............. Amount $ .............................

Next payment due on the .................................... day of ....................................... 20............. Amount $ .............................

Remaining payments to be made —

Number

Amounts

Frequency

Name and address of guarantor (if applicable) ...................................................... ................................................................................................................................

* State what relief is sought

* SICKNESS

(i)

I ceased work on the ................... day of .................................... 20............

(ii)

Give details of sickness and likely duration ................................................ ...................................................................................................................... ......................................................................................................................

(iii)

My employer is ............................................................................................ ......................................................................................................................

(full name and address)

(iv)

I registered for sickness benefit with the Department of Social Security at ................................. on the ....................... day of .................... 20.............

(v)

Give details of any other application for sickness benefits ......................... ...................................................................................................................... ......................................................................................................................

(vi)

Give details of any benefits being received ................................................. ...................................................................................................................... ......................................................................................................................

* UNEMPLOYMENT

(i)

I am unemployed and have been from the ................................... day of ................................... 20.........

(ii)

My employer was ........................................................................................ ......................................................................................................................

(full name and address)

(iii)

I registered for unemployment benefits with the Commonwealth Employment Service at ....................... on the ................................. day of ..................................... 20...........

(iv)

The details of unemployment benefits being received by me are as follows ......................................................................................................... ...................................................................................................................... ......................................................................................................................

(* Complete whichever is applicable.)

Financial position and income of applicant ........................................................... ................................................................................................................................ ................................................................................................................................ ................................................................................................................................

Financial commitments of applicant ...................................................................... ................................................................................................................................ ................................................................................................................................ ................................................................................................................................

Details of family

Name

Husband,

wife, de facto partner or

child

Age

Whether financially

dependent upon

applicant

Weekly

income

If the default is due to sickness what is the likely duration of the sickness? ...............................................................................

If the default is due to unemployment what is the likely duration of the unemployment? .....................................................

What effect would a refusal of relief have on your financial circumstances? ...............................................................................

Are the goods the subject of the hire‑purchase agreement necessary for your livelihood? ...............................................................

If the goods the subject of the hire‑purchase agreement are necessary for your livelihood what effect would a breach of the agreement have on your financial circumstances?

What is the extent of your equity in the goods the subject of the hire‑purchase agreement? ...............................................................

What obligations would arise in the event of a breach of the hire‑purchase agreement? ...............................................................

What would be the consequences of a breach of the hire‑purchase agreement for any guarantor of the hire‑purchase agreement? ...................................................

......................................... ..................................................................

Date Signature

NOTE:

1. A copy of this application must be served on the owner and every guarantor.

2. The decision of the Commissioner has effect according to its terms and where relief is granted the hire‑purchase agreement and any contract of guarantee relating to it are varied to the extent necessary.

3. A grant or refusal of relief by the Commissioner shall be by instrument in writing signed by him and served on the hirer, owner and every guarantor.

4. An owner, hirer or guarantor aggrieved by the decision of the Commissioner may apply to the State Administrative Tribunal for a review of the decision.

[Form 2 amended: Gazette 30 Jun 2003 p. 2604; 30 Dec 2004 p. 6922.]

Form 3

Hire‑Purchase Act 1959 Infringement notice		Infringement notice no.
Alleged offender	Name: Family name
	Given names
	or Company name _____________________________________ ACN
	Address _________________________________________________ Postcode
Alleged offence	Description of offence ______________________________________
	Hire‑Purchase Act 1959 s.
	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 — Hire‑Purchase Act 1959’) to: Approved Officer — Hire‑Purchase Act 1959 Department of Consumer and Employment Protection Locked Bag 14 Cloisters Square Perth WA 6850 In person: Pay the cashier at: Department of Consumer and Employment Protection 219 St George’s Terrace, Perth WA 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 _______________________________________________ and post this notice to the Approved Officer at the above postal address within 28 days after the date of this notice.

[Form 3 inserted: Gazette 22 Sep 2006 p. 4117; amended: Gazette 20 Aug 2013 p. 3835; SL 2020/163 r. 34.]

Form 4

Hire‑Purchase Act 1959 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 ______________________________________
	Hire‑Purchase Act 1959 s.
	Date / /20 Time a.m./p.m.
Officer withdrawing notice	Name
	Signature
	Office
Date	Date of withdrawal / /20
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: Approved Officer — Hire‑Purchase Act 1959 Department of Consumer and Employment Protection Locked Bag 14 Cloisters Square Perth WA 6850 Signature / /20

[Form 4 inserted: Gazette 22 Sep 2006 p. 4117‑18.]

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