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Application for Internal Review for Infringements Only

    Application for Internal Review for Infringements Only

    Please complete all sections below to have your Infringement reviewed. Only one Internal Review may be submitted per Infringement Notice.

    Section 1 - Applicant’s Details

    The person making the application. Please check the relevant box.



    You are * (required)

    Section 2 - Infringement Details

    Please complete a separate form for each infringement you wish to have reviewed.

    Section 3 - Grounds for Application






    Please check the relevant box (See descriptions below)
    By checking this box I understand that this is the only Internal Review for this Infringement that I am able to submit pursuant to s.22 (2) (e) of the Infringements Act 2006. * (required)

    Consent for Internal Review

    To be completed if another person is acting on your behalf.
    Please check box to agree (for person named on the infringement):
    Please check box to agree (other person with consent):

     

     

    Description of Relevant Grounds for Internal Review Appeal

    1. Exceptional Circumstances
    Please provide details of the exceptional circumstances (where you have committed the offence due to unforeseen or unpreventable circumstances, e.g. medical emergencies).

     

    2. Contrary to Law
    Please provide the reasons why you consider the decision to issue you with an Infringement was unlawful (e.g. the Infringement was not valid).

     

    3. Special Circumstances
    Special circumstances includes:

    • A mental or intellectual disability, disorder, disease or illness
    • A serious addiction to drugs, alcohol or volatile substance
    • Homelessness, or
    • Family violence within the meaning of the Family Violence Protection Act 2008.

     

    You must provide evidence (e.g. letter, report, statement) from one of the following parties to support you application:

    • A case worker, case manager or social worker
    • A general practitioner, psychiatrist or psychologist, or
    • An accredited drug treatment agency.

     

    Evidence (e.g. letter, statement or a report) from practitioner or case worker should include the following information:

    • The practitioner or case worker’s qualification and relationship with you, including the period of engagement
    • The nature, severity and duration of your condition or your circumstances:
      a) Whether you were suffering from the relevant condition or circumstances at the time the offence was committed, and
      b) Whether, in the opinion of the practitioner or case worker, it is more likely than not that your condition or circumstances resulted in your inability to understand or control the conduct constituting the offence.

     

    The practitioner or agency report must show that because of your condition or situation you could not understand or control constituting the offence.

     

    4. Mistaken Identity
    Please provide an explanation of why you rely on the ground of mistake of identity (including evidence e.g. copy of your driver’s licence, in support).

     

    5. Person Unaware of Fine
    An application made on the ground of ‘person unaware’ must:

    • Be made within 14 days of you becoming aware of the infringement notice (You may evidence the date that you became aware of the infringement notice by executing a statutory declaration)
    • State the grounds on which the decision should be reviewed
    • Provide your current address for service.

     

    6. Penalty Reminder Notice Additional Costs Waiver Request
    Please provide the reason/s why you believe the Penalty Reminder Notice Additional Costs should be waived. Note: The original penalty amount is still applicable under this request.

    Applicants please note: If you do not provide sufficient information, the enforcement agency may request further information. If you do not provide this further information within 28 days of the date of request, the enforcement agency may determine the application without the further information.