Withdraw Infringement Form | West Coast Council

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Download Application to Withdraw Infringement

Application to Withdraw Infringement

This form must be submitted within 28 days of the infringement date

Infringement Details

Ínfringement Number(Required)

Vehicle Registration Number(Required)

Driver Details

Were you the driver of the vehicle at the time the infringement was issued

Yes

Do you want to nominate the driver who was driving the vehicle at the time of the infringement

Yes

If you were not the registered owner or operator of the vehicle on the date of the infringement, please complete a Statutory Declaration, providing details of the person who was the registered owner or who was in charge of the vehicle at the time of the offence.

Statutory Declaration forms can be obtained from Council or downloaded from the Tasmanian Governement Department of Justice website.

Download Forms

Please make sure the Statutory Declaration is properly witnessed before submlitting.

You must nominate a driver to submit an Application to Withdraw.

Please select another option or call Council on (03) 6471 4700

Upload Statutory Declaration(Required)

Max. file size: 150 MB.

Name(Required)

First Last

Date of Birth(Required)

Australian Residential Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone

Please Note. This form is optional but if no email address is supplied we will not be able to send a confirmation email.

Reason(s) to Withdraw Infringement

Provide clear and detailed reasons why you are requesting the infringement notice to be withdrawn

Details

If the General Manger refuses your application, you may:

Pay the fine in full
Apply for a payment arrangement, or
Elect to go to court