LOCAL LAWS – Application for Internal Review Application for Internal Review of an Infringement Notice 1Introduction2Application You can use this form to You can use this form to apply for an internal review to dispute Animal, Local Laws and Parking Infringements (often called a 'fine') issued by Council if you believe the decision: was contrary to law involved a mistake of identity that special circumstances apply you were unaware of the infringement if there are other exceptional circumstances Please note: Only ONE Internal Review may be submitted per Infringement Notice, unless applying when an internal review has been granted on the ground of Person Unaware of Fine. Who can use this form Person named on the infringement notice Driver of the vehicle Nominated representative While completing this form, we will request Details of the person named on the infringement notice Details of the nominated representation of someone else named on the infringement notice (if applicable) Grounds for your application It will take about 10 minutes to complete this form. After you submit this form We will send you an email receipt to confirm we have received your application All enforcement action will be suspended until the review has been completed Your application will be assessed and you will be notified in writing within 14 business days You may be requested in writing to provide further information if sufficient information is not provided. If you do not provide this further information within 21 days of the date of request, the enforcement agency may determine the application without further information. What happens with your information? Information requested on this form is required by Swan Hill Rural City Council in order to process your application. We will handle any personal information you provide on this form in accordance with the Privacy and Data Protection Act 2014. We record this information on our customer databases and make it available to relevant Council staff in line with our Privacy Statement. You can access your personal information by contacting our Privacy Officer. Applicant detailsWho is submitting this application?(Required) I am the person named on the infringement notice I am applying for someone else named on the infringement notice I am applying on behalf of a company that has received an infringement notice I am the driver of a vehicle that had an infringement notice attached to it I am the owner of a vehicle (not the driver) that had an infringement notice attached to it First name(Required)Surname(Required)Phone(Required)For landline phones include 03 area codeEmail(Required) Company detailsCompany name(Required)ACN (if applicable)Your role within the company(Required)Postal address for correspondence(Required) Street Address Town / Suburb State Post Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussian FederationRwandaSaint 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 TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Consent details We cannot accept your application unless its is accompanied by proof that you can act on the other person's behalf. This might be a letter from the other person, or a copy of a Power of Attorney, or similar.Please upload proof of right to act on other person's behalf or Power of Attorney (or similar) Drop files here or Select files Accepted file types: heic, jpg, gif, png, pdf, Max. file size: 3 MB, Max. files: 1. Infringement detailsInfringement type Parking Animals Local Laws Environment Protection Other Infringement notice number(Required) Add RemoveGrounds for application(Required) Exceptional Circumstances Contrary to Law Special Circumstances Mistaken Identity Person Unaware of Fine Penalty Reminder Notice Fee Waiver Request Exceptional Circumstances Please provide details of the exceptional circumstances (where you have committed the offence due to unforeseen or unpreventable circumstances, e.g. medical emergencies).Contrary to Law Please provide the reasons why you consider the decision to issue you with an Infringement was contrary to law. For example, this ground can be used if you believe that the infringement notice is not valid, or that an infringement officer has acted unlawfully or beyond their authority in taking that action or decision.Special Circumstances Special circumstances includes: a mental or intellectual disability, disorder, disease or illness a serious addiction to drugs, alcohol or volatile substance homelessness family violence within the meaning of the Family Violence Protection Act 2008 a long term circumstance or condition making it impracticable to deal with the fine You must provide evidence (e.g. letter, report, statement) from one of the following parties to support your application. a case worker, case manager or social worker a general practitioner, psychiatrist or psychologist an accredited drug treatment agency Evidence (e.g. letter, statement or a report) from practitioner or case worker 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, in the opinion of the practitioner/case worker, your condition/ circumstances: a) contributed to a significantly reduced capacity to understand or control the conduct constituting the offence, or b) make it impracticable to deal with your fine Mistaken Identity Please provide an explanation of why you rely on the ground of mistake of identity (including evidence e.g. copy of your driver’s licence, in support).Person Unaware of Fine 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. 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.Explanation detailsPlease give supporting evidence/reasons why you believe the infringement notice should be withdrawn(Required)Upload supporting documentsUpload any documentation in support of your application Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, heic, pdf, Max. file size: 3 MB, Max. files: 5. Declaration detailsDeclaration 1(Required) I understand that this is the only Internal Review for this Infringement that I am able to submit pursuant to s.22(2) of the Infringements Act 2006(Required) Declaration 2(Required) I declare that the information that I have supplied in this form, and any attachments to this form, are true and correct to the best of my knowledge(Required) Declaration 3(Required) I understand that by making a false or misleading statement in support of this claim, I may be prosecuted(Required) Declaration 4(Required) I declare that I am authorised to submit this application on behalf of the company(Required)
