Western Australian Consolidated Regulations[r. 117]
Form 1 — Infringement notice
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Trade Measurement Administration Act 2006 Infringement notice |
Infringement | |
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Alleged offender |
Name: Family name | |
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Given names | ||
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or Company name ACN | ||
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Address Postcode | ||
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Alleged offence |
Description of offence | |
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OR | ||
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Date / /20
Time a.m./p.m. | ||
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Modified penalty $ | ||
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Inspector issuing notice |
Name | |
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_________________________________________ | ||
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Date |
Date of notice / /20 |
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Notice to alleged offender |
It is alleged that you have committed the above offence. | |
| |
In person: Present this notice and your payment to the cashier at: If you do not pay the modified penalty within 28 days, you may be
prosecuted. | |
| |
If you need more time to pay the modified penalty, you can apply for an
extension of time by writing to: If you want this matter to be dealt with by prosecution in court , sign here
| |
Form 2 — Withdrawal of infringement notice
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Trade Measurement Administration Act 2006 ; s. 25 Withdrawal of infringement notice |
Withdrawal no. | |
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Alleged offender |
Name: Family name | |
|
Given names | ||
|
or Company name ACN | ||
|
Address | ||
|
Infringement notice |
Infringement notice no. | |
|
Date of issue / /20 | ||
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Alleged offence |
Description of offence | |
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Trade Measurement Act 2006 s. | ||
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Date / /20
Time a.m./p.m. | ||
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Authorised person giving this notice |
Name | |
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_________________________________________ | ||
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Date |
Date of withdrawal /
/20 | |
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Withdrawal of infringement notice |
The above infringement notice issued against you has been withdrawn. | |