​ሕግንና ደንብን በተመለከተ እርዳታ ማግኘት ይፈልጋሉን? - Amharic | هل تحتاج لمساعدة قانونية؟ - Arabic | ܤܢܝܼܩܵܐ ܝ݇ܘ̤ܬ ܠܗܲܝܵܪܬܵܐ ܩܵܢܘܿܢܵܝܬܵܐ؟ - Assyrian | Need Legal Help? - Auslan | Treba li vam pravna pomoc? - Bosnian | Burmese â Need Legal Help? | 需要法律帮助吗? - Chinese Simplified | 需要法律幫助嗎? - Chinese Traditional | Trebate li pravnu pomoć? - Croatian | ضرورت به کمک قانونی دارید؟ - Dari | Wïc Kuɔɔny në Wɛ̈t Löŋ? - Dinka | آیا به کمک حقوقی نیاز دارید؟ - Farsi | Gadreva na Veivuke Vakalawa? - Fijian | Kailangan ninyo ba ng tulong na panglegal? - Filipino | Besoin d’aide juridique ? - French | Χρειάζεστε βοήθεια σε νομικά ζητήματα - Greek | क्या आपको कानूनी सलाह चाहिए? - Hindi | Butuhkan Bantuan dalam Masalah Hukum? - Indonesian | Hai bisogno di assistenza legale? - Italian | ត្រូវការជំនួយលើបញ្ហាផ្លូវច្បាប់ឬទេ? - Khmer | 법적인 도움이 필요하십니까? - Korean | Ви треба ли помош со правни работи? - Macedonian | कानूनी सहयोग चाहिएको छ? - Nepalese | Necessita de ajuda com questões jurídicas? - Portuguese | Вам нужна юридическая помощь? - Russian | E Manaomia Fesoasoani i Mea Tau Tulafono? - Samoan | а ли вам треба помоћ у правним питањима? - Serbian | Ma u baahan tahay Caawimmad xagga sharciga ah?- Somali | ¿Necesita ayuda con cuestiones jurídicas? - Spanish | சட்ட உதவி தேவையா? - Tamil | ท่านต้องการความช่วยเหลือทางด้านกฎหมายไหม? - Thai | Fiema’u ha tokoni Fakalao? - Tongan | Yasal Danışmaya İhtiyacınız mı var? - Turkish | Cần Được Giúp Đỡ Về Luật Pháp? - Vietnamese |

Sample Court Election Form - Companies ​

Icon - sample/instructions This is a text only version of a Sample Court Election Form - Companies. It is not legal advice.

To see what a completed form could look like, see the pdf version of Sample Court Election Form - Companies PDF icon (137 kb).

If you need more help, call LawAccess NSW.


Enquiries 1300 655 805

TTY 133 677 Speak and Listen 1300 555 727 Email us via: www.sdro.nsw.gov.au/contact/

Court Election Form - Companies

To have your penalty notice decided in court 

Note:           ​
  • You may wish to request a review before going to court, if you have not already. If the outcome is not in your favour, you will have a further 28 days to advise us if you want to have the penalty decided in court
  • If you want us to conduct a review, do not submit this request to have the penalty decided in court. By law, we must stop any review which may be in progress when we receive a request to go to court
  • Print clearly using BLOCK LETTERS in the space provided
  • If all sections are not completed, your application cannot be processed
  • Do not pay the fine before lodging this form
  • Court may impose additional costs
  • Please send your completed form to State Debt Recovery Office, PO Box 786, Strawberry Hills NSW 2012

I elect to have Penalty Notice No. 1010101010 determined by a court. 

I understand the Company named on the penalty notice will receive a Court Attendance Notice (CAN) and a representative will have to go to court. 

Company name HA Packaging Pty Ltd 

Full name of person completing court election form Harry Anderson 

Position (duly authorised to sign on behalf of the company) Director 

I elect to receive the company CAN by Email (Note: If the email box is not selected the CAN will be sent by post.) 

Company email hapackaging@pmail.com

Company address 1/141 Sample Road 

Suburb Lilyfield 

State NSW 

Postcode 2040 

Country Australia 

Best contact no. 9999 8888 

Signature H. Anderson 

Date 20/03/2014 

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Office of State Revenue: ISO 9001 - Quality Certified | Department of Finance & Services

State of New South Wales through the Office of State Revenue, 2013. This work may be freely reproduced and distributed for most purposes, however some restrictions apply. Read the copyright notice at www.osr.nsw.gov.au or contact OSR.