Western Australian Consolidated Regulations

DANGEROUS GOODS SAFETY (GENERAL) REGULATIONS 2007 - SCHEDULE 2

[r. 3]

1 .         Infringement notice (r. 12)

Dangerous Goods Safety Act 2004 s. 56 Dangerous Goods Safety (General) Regulations 2007				Infringement notice Number:
Alleged offender (individual)	Family name
	Given names
	Address
	Date of birth				Male/Female
	Driver’s licence	No.:         State/Country: Type:         Class(es):         Expiry date:
Alleged offender (body corporate)	Name
	ACN					ABN
	Address
Description of alleged offence	Date				Time
	Place
	Details 1
	Regulation contravened 2
Modified penalty	The modified penalty for the alleged offence is $
Vehicle details 3	Plate. No.		State
	Licence expiry date		Vin/Chassis No.
	Make		Colour
	Body type
Date of notice
Service details [Tick one box]	This notice was served — in person by post.				Date
Officer issuing notice	Name
	Office
	Signature
Notice to alleged offender	It is alleged that you have committed the above offence. If you want the alleged offence dealt with in court, tick the box below, post this notice to the address below, and do not pay the modified penalty above. If you do not wish to be prosecuted for the alleged offence in court, pay the modified penalty above within 28 days after the date on which you receive this notice. To pay, tick the relevant box below and post this notice and any cheque or credit card details for the modified penalty to the address below. If you want an extension of time to pay the modified penalty, contact the Chief Dangerous Goods Officer at the address below. Paying the modified penalty will not be taken to be an admission for the purposes of any civil or criminal court case. If you do not pay the modified penalty, you may be prosecuted in court for the alleged offence and, if convicted, you will be liable to a penalty and costs.
Alleged offender’s response [Tick one box]	To — Resources Safety Department of Mines and Petroleum Mineral House 100 Plain Street East Perth WA 6004         I want this alleged offence dealt with by a court.         Cheque for the modified penalty enclosed.         I want to pay the modified penalty by using a credit card. The credit card’s details are:

Notes to Form 1 —
1.         The details should say what the alleged offender has done that is a contravention of the law.
2.         Include here the name of the regulations and the number of the regulation contravened.
3.         Include vehicle details if alleged offence relates to a vehicle or to a person driving a vehicle.

        [Form 1 amended in Gazette 22 Jun 2010 p. 2781.]

2 .         Withdrawal of infringement notice (r. 13)

Dangerous Goods Safety Act 2004 s. 56 Dangerous Goods Safety (General) Regulations 2007			Withdrawal of infringement notice
Alleged offender	Family name
	Given names
	Address
Infringement notice	Number
	Date issued
Description of alleged offence	Date			Time
	Place
	Details
	Regulation contravened
Date of this notice
Officer issuing this notice	Name
	Office
	Signature
Notice to alleged offender	The above infringement notice, which was issued for the above alleged offence, has been withdrawn. If you have already paid the modified penalty in accordance with the infringement notice, you are entitled to a refund of the money. To obtain a refund post this notice to — Resources Safety Department of Mines and Petroleum Mineral House 100 Plain Street East Perth WA 6004

        [Form 2 amended in Gazette 22 Jun 2010 p. 2782.]