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Driver Nomination Form

I

Please enter the full name of the vehicle owner

of

address and postcode

Please enter your email so we can get in touch.

12 characters left

(N.B. If a company owned vehicle, state your position in the company and registered office of the company below)

The number on the top of your parking fine notice

10 characters left

PART 2 - Nomination - Complete either option A OR B below

OPTION A

At the time of the alleged offence, the vehicle was

Full name or company name

Address

OPTION B - I was the owner of the above named vehicle but was not the driver

OPTION B—I was the owner of the above named vehicle but was not the driver. To the best of my knowledge and belief, at the time of the alleged offence, the driver was:

(FULL NAME or COMPANY NAME)

(ADDRESS AND POSTCODE)

WARNING: Under section 174A (13) of the Road Traffic Act 1961, there is a maximum penalty of $25,000 or four (4) years imprisonment for making a statement that is false or misleading in a material particular, when making a nomination. You may be asked to make a statutory declaration to verify any information in this nomination.
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