Western Australian Consolidated Regulations

TOBACCO PRODUCTS CONTROL REGULATIONS 2006 - SCHEDULE 5

[r. 62]

        [Heading inserted in Gazette 10 Sep 2010 p. 4397.]

Form 1 — Infringement notice

Tobacco Products Control Act 2006 Infringement notice		Infringement notice no.
Alleged offender	Name:         Family name
	Given names
	or         Company name ______________________________________________         ACN
	Address ______________________________________________         Postcode
Alleged offence	Description of offence ______________________________________________
	Tobacco Products Control Act 2006 s.  or Tobacco Products Control Regulations 2006 r.
	Date         /         /20         Time         a.m./p.m.
	Modified penalty $
Officer issuing notice	Name
	Signature
	Office
Date	Date of notice         /         /20
Notice to alleged offender	It is alleged that you have committed the above offence. If you do not want to be prosecuted in court for the offence, pay the modified penalty within 28 days after the date of this notice. How to pay By post:         Send a cheque or money order (payable to ‘Approved Officer — Tobacco Products Control Act 2006 ’) to:         Approved Officer — Tobacco Products Control Act 2006         [Relevant authority and address] In person:         Pay the cashier at:         [Relevant authority and address] If you do not pay the modified penalty within 28 days, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994 . Under that Act your driver’s licence and/or vehicle licence may be suspended. If you need more time to pay the modified penalty, you can apply for an extension of time by writing to the Approved Officer at the above postal address. If you want this matter to be dealt with by prosecution in court, sign here: _______________________________________ and post this notice to the Approved Officer at the above postal address within 28 days after the date of this notice.

        [Form 1 inserted in Gazette 10 Sep 2010 p. 4397-9.]

Form 2 — Withdrawal of infringement notice

Tobacco Products Control Act 2006 Withdrawal of infringement notice		Withdrawal no.
Alleged offender	Name:         Family name
	Given names
	or         Company name ______________________________________________         ACN
	Address ______________________________________________         Postcode
Infringement notice	Infringement notice no.
	Date of issue         /         /20
Alleged offence	Description of offence ______________________________________________
	Tobacco Products Control Act 2006 s.  or Tobacco Products Control Regulations 2006 r.
	Date         /         /20         Time         a.m./p.m.
Officer withdrawing notice	Name
	Signature
	Office
Date	Date of withdrawal         /         /20
Withdrawal of infringement notice [*delete whichever is not applicable]	The above infringement notice issued against you has been withdrawn. If you have already paid the modified penalty for the alleged offence you are entitled to a refund. *         Your refund is enclosed. or *         If you have paid the modified penalty but a refund is not enclosed, to claim your refund sign this notice and post it to:         Approved Officer — Tobacco Products Control Act 2006         [Relevant authority and address] Signature         /         /20

        [Form 2 inserted in Gazette 10 Sep 2010 p. 4399-400.]