Please complete all sections below to have your infringement reviewed.
Note: ONLY ONE Internal Review may be submitted per Infringement Notice, unless related to the same set of circumstances.
Application for Internal Review Form
Descriptions of Relevant Grounds for Internal Review
1 Exceptional Circumstances
Please provide details of the exceptional circumstances surrounding your case and provide reasons why your circumstances or situation are such that the infringement should be Withdrawn or an Official Warning issued.
2 Contrary to Law
Please provide the reasons why you consider the decision to issue you with an infringement unlawful.
3 Special Circumstances
Special circumstances includes:
- a mental or intellectual disability, disorder, disease or illness
- a serious addiction to drugs, alcohol or volatile substance
- homelessness, or
- family violence within the meaning of the Family Violence Protection Act 2008.
You must provide evidence (e.g. letter, report, statement) from one of the following parties to support you application.
- a case worker, case manager or social worker
- a general practitioner, psychiatrist or psychologist, or
- an accredited drug treatment agency.
Evidence (e.g. letter, statement or a report) from practitioner or case work should include the following information:
- the practitioner/case worker’s qualification and relationship with you, including the period of engagement
- the nature, severity and duration of your condition or your circumstances:
- whether you were suffering from the relevant condition or circumstances at the time the offence was committed, and
- whether, in the opinion of the practitioner/case worker, it is more likely than not that your condition/ circumstances resulted in your inability to understand or control the conduct constituting the offence.
The practitioner or agency report must show that because of your condition/situation you could not understand or control constituting the offence.
4 Mistaken Identity
Please provide the reason/s why you believe there has been a case mistake of identity and identify the name and address of the person involved and the relationship of that person to you if relevant.
5 Penalty Reminder Notice Fee Waiver Request
Please provide the reason/s why you believe the Penalty Reminder Notice Fee should be waived. Note: The original penalty amount is still applicable under this request.
6 Person unaware
An application made on the ground of ‘person unaware’ must:
- be made within 14 days of you becoming aware of the infringement notice (You may evidence the date that you became aware of the infringement notice by executing a statutory declaration)
- state the grounds on which the decision should be reviewed, and
- provide your current address for service.
Applicants please note:
If you do not provide sufficient information, the enforcement agency may request further information. If you do not provide this further information within 21 days of the date of request, the enforcement agency may determine the application without the further information.
Consent for Internal Review
This must be completed and attached above if another person is acting on your behalf. This must be written/typed on a piece of paper, signed and attached as a clear photograph or as a scanned attachment.
I (person named on infringement), of (address), give my consent to (name of person making the application on your behalf) to apply for an internal review on my behalf to infringement number/s (provide infringement number/s)
- Signed (by person named on infringement), Date:
- Signed (other person with consent), Date: