Parking Fine Review – Nomination Statement 1Introduction2 Infringement Information3Nomination Statement4Your details5Review Use this form If you were not the person/corporation in possession or control of the vehicle at the time of the offence, you should tell us who was driving, in order to transfer liability. You should apply to nominate if: someone else was the driver responsible for the vehicle at the time of the offence you sold the vehicle to someone else or disposed of the vehicle before the offence date you believe the vehicle or number plates displayed on the vehicle were stolen you do not know and cannot identity the person in possession of the vehicle at the time of the alleged offence you were incorrectly nominated as the responsible person You cannot nominate another driver if: you were issued with an on-the-spot fine at the time of the offence. Your nomination may not be accepted if you cannot properly identify the person responsible. Before you begin Have the infringement number and vehicle registration number handy. To complete this form Ensure you fill out all the required fields. After you submit this form We will contact you if the nomination form is incomplete and ask you to complete a new form. We will notify you of the outcome. If your nomination application is accepted, your fine will be withdrawn and reissued to the person you have nominated. The person you nominate can reject the nomination. If this occurs, you will be notified and the fine will be reissued to you. What happens with your information? We record your information on our customer database and make it available to relevant Council staff in line with City of Boroondara’s Privacy Statement. The contact details you provide to Council may be used by Council to contact you in relation to other Council functions and services. Infringement Notice Number * Required The infringement notice number can be found on your infringement notice and is exactly 8 digits (numeric), and contain no spaces. Vehicle Registration Number * Required What action do you want to take? * Required Submit a nomination statement Request a court hearing I, the responsible person/the authorised corporate officer, was not the person/the corporation in possession or control of the vehicle at the time of the alleged offence because (select appropriate option): * Required Someone else was the driver in possession or control of the vehicle at the time of the alleged offence. I sold this vehicle to someone else or permanently disposed of the vehicle. I believe the vehicle or number plates displayed on the vehicle were stolen. I do not know and cannot identify the person in possession of the vehicle at the time of the alleged offence. I was incorrectly nominated as the responsible person in relation to the vehicle and I reject the nomination. When you disposed the vehicle? * Required DD slash MM slash YYYY Upload police report or reference number * Required Drop files here or Select files Accepted file types: pdf, doc, docx, jpg, jpeg, png, tiff, Max. file size: 5 MB, Max. files: 2. Maximum file size – 5 mega bytes. Note:The statement “I do not know and cannot identify the person in possession of the vehicle at the time of the alleged offence” cannot be selected where the alleged offence involves a taxi-cab. Who was in possession or control of the vehicle at the time of the alleged offence? * Required A person A corporation Name of the person * Required First Name Surname Name of the corporation * Required Corporation ACN * Required Address * RequiredHiddenAddress Phone numberDriver licence / permit number? Country of issue * Required Australia Other Select the country * Required AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Name of the country Select the state * Required Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia State Date of birth of the driver * Required DD slash MM slash YYYY Date of birth of the driver DD slash MM slash YYYY Is the vehicle a taxi-cab? * Required No Yes Taxi DC number * Required Driver's accreditation number * Required Tell us what reasonable and diligent enquiries you've made to try to identify the person in possession or control of the vehicle at the time of the alleged offence, or why you are rejecting the nomination * RequiredNote:Failure to keep a record of who was in possession or control of the vehicle involved in the alleged offence is not an adequate reason unless you can prove exceptional circumstances. If the alleged offence involves a taxi-cab you cannot nominate another person if you are recorded as the driver in the operator’s records, and you cannot claim you are not aware of, or cannot identify the driver. Your name * Required First name Surname Address * RequiredHiddenAddress Note: Is your Address Correct? If not, notify VicRoads or your relevant licencing authority of any changes.Note:Court summons will be sent to this addressCorporation (if applicable) Your driving license Your date of birth * Required DD slash MM slash YYYY Your date of birth DD slash MM slash YYYY Your email * Required Your phone number * RequiredDeclaration * Required It is an offence under the Road Safety Act 1986 (which may carry a fine of 60 penalty units and potential licence loss for an individual, or a fine 120 penalty units for a body corporate) to knowingly provide false or misleading information in a a nomination statement. I understand that I may be served with a summons to give evidence in relation to this nomination. Declaration * Required I decline to have this matter dealt with under these enforcement provisions and want to have the matter heard and determined by a Court. I understand I may receive a summons/Notice of Hearing for this alleged offence. Please review your information. If you notice errors please use the numbered page navigation or the ‘previous’ button to make changes. If all information is correct, please click the ‘Submit’ button to complete this form. {all_fields:exclude[6,54,51,57,53]}
