Transport Co-ordination Regulations 1985

[r. 13(2) and (3)]

[Heading inserted: Gazette 5 Aug 2016 p. 3313.]

FORM 1

Transport Co‑ordination Act 1966 section 58A

Transport Co‑ordination Regulations 1985 regulation 13(2)

Western Australia

Department of Transport

TRANSPORT CO‑ORDINATION INFRINGEMENT NOTICE

PART “B” This space for cash register imprint

To be retained by Cashier.

OFFICE COPY ONLY

Please do not detach from Part “A”

PART “A”

OFFICIAL RECEIPT

ALLEGED OFFENDER’S COPY No. .....................

Issue Date ........../........../........

Date of birth ........../........../........

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

Surname (block letters) Other Names (in full)

Driver’s licence number .....................................................................

Address ................................................................................................

Number and Street Town or Suburb Postcode

Particulars of public vehicle

Number plate No. ............................

Make ................................................

Model ...............................................

Colour ..............................................

Company ..........................................

It is alleged that at .............. hours on ............ day of ................. 20.... at ............................................................................................................ you committed the offence of ...............................................................

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

Description of offence

Modified penalty $ ..................................

.................................................... No. .............................

Signature of authorised person

Take notice that —

If you do not wish to be prosecuted for the alleged offence in a court, the amount of money specified above as the modified penalty for the offence may be paid to an authorised person (specified below), within 28 days after the notice is given.

If that amount is not paid within 28 days, additional administrative charges may be incurred and 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.

Payment may be made —

[The authorised persons to whom payment may be made are to be specified here.]

Payments will not be accepted at any Department of Transport office.

A receipt will not be mailed unless requested.

Court:

If you wish the matter to be dealt with by a court, do not pay the modified penalty on this infringement notice. You should advise ................................................................ at .................................... of your intentions in writing, before the due date otherwise further costs will be incurred.

Inquiries should be made in writing and forwarded by post to —

[Insert appropriate address here]

TRANSPORT CO‑ORDINATION INFRINGEMENT NOTICE CREDIT CARD SLIP

Do not detach — Return complete document with payment to —

[Insert appropriate address here]

Please debit my credit card account —

Mastercard Visacard

Card Number

Amount ................................................................................................

Cardholder Name ................................................................................

Signature ........................................... Expiry Date ............./..............

[Form 1 inserted: Gazette 5 Aug 2016 p. 3313-15; amended: SL 2020/172 r. 8.]

FORM 2

Transport Co‑ordination Act 1966 section 58A

Transport Co‑ordination Regulations 1985 regulation 13(3)

Western Australia

Department of Transport

NOTICE OF WITHDRAWAL OF TRANSPORT CO‑ORDINATION INFRINGEMENT NOTICE

Notice No. .......................................

Name and address of alleged offender

An infringement notice given to you has been withdrawn.

[Identifying details of infringement notice]

Date of withdrawal ........./........../.............

The amount of $ ................... paid by way of modified penalty will be refunded.

No further action will be taken*

A summons will be issued*

[*Delete whichever is not applicable]

Authorised person who sent this notice

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

Name Signature

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

Date signed

[Form 2 inserted: Gazette 5 Aug 2016 p. 3315.]