​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 Payment by Instalments - Companies

Icon - sample/instructions This is a text only version of a Sample Payment by Instalments - Companies. It is not legal advice.

To see what a completed form could look like, see the pdf version of Sample Payment by Instalments - Companies PDF icon(238kb).

If you need more help, call LawAccess NSW.​


Enquiries 1300 655 805
TTY 133 677  Speak and Listen 1300 555 727
Email us via: http://www.revenue.nsw.gov.au/contact
Website http://www.revenue.nsw.gov.au

Payment by Instalments - Companies

To apply to pay your fine by instalments.

Note:

  • Print clearly using BLOCK LETTERS in the space provided and tick the appropriate boxes
  • If all sections are not completed, your application cannot be processed
  • Please send your completed form to State Debt Recovery, PO Box A2571, Sydney South
    NSW 1235; or scan and email us via http://www.revenue.nsw.gov.au/contact

Company details

Company name. HA Packaging Pty Ltd

ABN 1234567890

Best contact no. 9999 8888

Mailing address. 1/141 Sample Road

Suburb Lilyfield

State NSW

Postcode 2040

Trading address As above

Suburb

State

Postcode

Overdue Fine No. 123456789

Is the company currently trading? Yes No

Name of company Bank/Credit Union. Eastpac Bank

Do you own vehicles? Yes No

Rego no(s) ABC 123 and XYZ 789

How much can the company afford to pay per fortnight? $ 40.00

Declaration

The information contained is true and correct and I am authorised by the company to complete this document.

Name Harry Anderson

Position Director

Signature H. Anderson

Date 20/03/2014

Privacy statement

Information collected from you for the purpose stated on this form may be provided to third parties with your consent or as required or permitted by law. OSR will correct or update your personal information at your request. Read more about privacy at www.osr.nsw.gov.au

Office of State Revenue: ISO 9001 - Quality Certified | Department of Finance, Services and Innovation

State of New South Wales through the Office of State Revenue, 2015. 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.

SDR 043  |  Payment by Instalments - Companies | December​​ 2015