Infringement - Application for Internal Review

Image title

INFRINGEMENT TYPE - PARKING

Applicant Details

Who is applying (confirm who is making the application)

Person named on the infringementOther person with consentAuthorised company representative

Full Name *

Corporate Name and ACN (if applicable)

Preferred method of contact (outcome will be sent here) *

MailEmail

Address of person/ Corporate *

Street address *

City *

State *

Postcode *

Email Address

Phone Number

Infringement Details

Infringement Notice Number *

Vehicle Registration Number *

Infringement Date *

Grounds for application

Person unaware: you did not know about the fineContrary to law: the fine is invalid or was improperly issued to youMistake of identity: the fine was issued to the wrong personExceptional circumstances: the offence occurred due to an extraordinary or unavoidable situationSpecial circumstances: you have serious personal issues, conditions or difficulties

Explanation of circumstances and ground(s) in support of application *

Attachments

Browse

Please upload any supporting documentation. Only images and PDF files

Declaration

I understand that this is the only internal review for this infringement that I am able to submit pursuant to s.22(2) of the Infringements Act 2006.
I declare that the information that I have supplied in this form and any attachments to this form, are true and correct to the best of my knowledge.
I understand that by making a false or misleading statement in support of this claim, I may be prosecuted.

Signature

Clear

I Have read the Warrnambool CIty Council Privacy Policy

Use of artificial intelligence disclosure: the Council officer undertaking the review of your form will be supported by artificial intelligence (AI). The role of AI is to collate and present evidence to Council officer. The officer will engage with your review request and all the original evidence themselves. No decisions on the outcome of your requested review will be made by AI.