Online Form - Parking Infringements - Nominate another driver

Applicant details

This form is a legal document and can be used as evidence in Court. Full name and address details of the driver must be provided or this nomination will not be accepted

Company

Title

First Name*

Last Name*

Date of birth*

Phone*

Email*

Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Postal address same as above?*

YesNo

Infringement details

Infringement number*

Vehicle registration*

Infringement date

Someone else was a driver

Title*

Mr
Mrs
Miss
Ms

First Name*

Last Name*

Contact Number*

Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Vehicle sold prior to the offence

Date sold

Maximum total combined file size is 10MB.

Vehicle transfer papers

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

The vehicle is stolen or plates are stolen

Police report number

Declaration

It is an offence under Section 9.11 of the Local Government Act 1995 to provide false or misleading information.*

I declare that I was not in possession and control of the vehicle at the time of the alleged offence and understand that providing false or misleading information is an offence.

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