Western Australian Consolidated Regulations

PORT AUTHORITIES REGULATIONS 2001 - SCHEDULE 4

[r. 111, 112]

Form 1

Port Authorities Act 1999

Infringement notice

Serial No .........................

Date ......./......./.......

To: ⁽¹⁾ ......................................................................................................................

of: ⁽²⁾ .......................................................................................................................

It is alleged that on ......./......./....... at ⁽³⁾ .................................................................

at ⁽⁴⁾ .........................................................................................................................

you committed the following offence — 

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

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

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

contrary to regulation/Schedule 1 clause ⁽⁵⁾ ..................... of the Port Authorities Regulations 2001 .

The modified penalty for the offence is $ .....................

If you do not wish to have a complaint of the alleged offence heard and determined by a court, the amount of the modified penalty may be paid to an authorised person ⁽⁶⁾ ..............................................................................................

at ⁽⁷⁾ ........................................................................................................................

within a period of 28 days after the giving of this notice.

Name of authorised person giving the notice ........................................................

Signature ...................................................

(1)         Name of alleged offender
(2)         Address of alleged offender
(3)         Time at which offence allegedly committed
(4)         Place at which offence allegedly committed
(5)         Regulation or clause designation
(6)         Description of authorised persons
(7)         Place where modified penalty may be paid

Form 2

Port Authorities Act 1999

Withdrawal of infringement notice

Serial No .........................

Date ......./......./.......

To: ⁽¹⁾ ......................................................................................................................

of: ⁽²⁾ .......................................................................................................................

Infringement notice No. ............................... dated ......./......./....... for the alleged offence of ...............................................................................................................

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

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

has been withdrawn.

The modified penalty of $ ........................

        *         has been paid and a refund is enclosed.

        *         has not been paid and should not be paid.

        *         Delete as appropriate

Name and title of authorised person giving this notice ........................................

Signature ...................................................

(1)         Name of alleged offender given the infringement notice

(2)         Address of alleged offender