Before You Begin

Application to Review a Fine

Infringements Act 2006 section 22

Only one Internal Review may be submitted per Infringement Notice, unless applying when an internal review has been granted on the grounds of Person Unaware of Fine.
All applications must be in writing, including your name and address.
Once your application is received, your infringement will be placed on hold whilst a review is undertaken.

Section 1 - Applicant's Details (the person making the application)

Please select

Person named on the Infringement noticeOther person with consent ( you must complete the 'Consent for Internal Review' on page 3)Authorised company representative

I, the person named on the Infringement, of the address given, give my consent to my representative to apply for an Internal Review on my behalf.

Applicant *

Home address

Postal address (if different) *

Mobile phone number

Home phone number

Work phone number

Email address *

Section 2 - Infringement Notice Details

What type of fine do you have?

ParkingAnimal Local Laws Fire PreventionLitterHealthOther

Infringement Number/s

Date of offence

Vehicle registration (parking fine only)

Vehicle make and colour (parking fine only)

Section 3 - Grounds for application

Please tick the relevant box (see descriptions below)

Exceptional circumstances (see description 1)Contrary to Law - (see description 2)Special circumstances (See description 3)Mistaken Identity (See description 4)Person unaware of fine (See description 5)Penalty Reminder Notice/fee waiver request (see description 6)

Reasons why you want the fine to be reviewed

Additional documents to support your application e.g. a statutory declaration, a photo, medical reports or a receipt.

Evidence

Browse

Evidence

Browse

Evidence

Browse

I understand that this is the only Internal Review for this Infringement that I am able to submit pursuant to s22(2) of the Infringements Act 2006. I declare that the information that I have supplied in this form, and any attachements 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. *

Acknowledgement

Please complete this section to confirm your application.

I acknowledge all details I have provided are correct, and accept the East Gippsland Shire Council Privacy Statement. *

Please wait, files are uploading..