Application to waive Regulated Parking Penalty Infringement Notice (PIN)

Note: Applications must be lodged within 28 days of infringement notice. Completion of this form in no way guarantees waiver of the infringement notice. Incomplete forms or documentation will result in your application being rejected.

In accordance with Section 22(1) of the State Penalties Enforcement Act 1999, the submission of a request to waive a Penalty Infringement Notice will not pause the timeframe to elect to have the matter heard before the Magistrates Court, being twenty-eight days (28) after the date of the infringement notice.

Applicant details

First Name *

Last Name *

Postal address *

Email Address *

Daytime phone *

Vehicle registration number *

Vehicle registration state *

Are you the registered owner of the vehicle? *

YesNo

NOTE: the registered owner must lodge a statutory declaration naming you as the responsible driver. This must be done before you submit your appeal. Click to download the statutory declaration template.

Infringement details

Infringement number *

Date of offence *

Grounds for appeal

Refer to the list of invalid reasons (reasons that will not be accepted as grounds for appeal).

Details *

Supporting documents

Statutory declarationProof of payment (ticket purchased)Valid permitLetter from hospital or doctorPolice reportTowing invoice

Upload your Statutory Declaration *

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Maximum 7 MB file upload limit.

Upload your proof of payment (ticket)

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Maximum 7 MB file upload limit.

Upload a copy of your valid permit

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Maximum 7 MB file upload limit.

Upload your letter from hospital or doctor

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Maximum 7 MB file upload limit.

Upload a copy of your Police report

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Maximum 7 MB file upload limit.

Upload a copy of your towing invoice

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Maximum 7 MB file upload limit.

Declaration

I hereby declare that the information provided by me on this form is true and correct in every respect. I hereby request the withdrawal of the above penalty infringement notice and understand that submission of this form in no way guarantees waiver of the infringement notice. *

I hereby acknowledge that the submission of a request to waive a Penalty Infringement Notice/s will not pause the timeframe to elect to have the matter heard before the Magistrates Court in accordance with Section 22(1) of the State Penalties Enforcement Act 1999, being twenty-eight days (28) after the date of the infringement notice *

Privacy statement

We are collecting your personal information for the purpose of assessing your Application to Waive Parking Infringement Notice (PIN). This collection is authorised under the Local Government Act 2009. You are providing personal information which will be used for the purpose of delivering services and carrying out Council business. Your personal information is handled in accordance with theInformation Privacy Act 2009and will be accessed by persons who have been authorised to do so. Your information will not be given to any other person or agency unless you have given Council permission or the disclosure is required by law

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