​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 Request for Review of a Penalty Notice

Icon - sample/instructions This is a text only version of a Sample Request for Review of a Penalty Notice. It is not legal advice.

To see what a completed form could look like, see the pdf version of Sample Request for Review of a Penalty Notice (340 kb).

If you need more help, call LawAccess NSW.


Enquiries 1300 138 118

TTY 133 677  Speak and Listen 1300 555 727

See over the page for full State Debt Recovery Office contact details.

Request for Review of a Penalty Notice

Note:

  • Print clearly using BLOCK LETTERS in the space provided and tick the appropriate boxes
  • If you do not provide supporting documents and if all sections are not completed, your application cannot be processed
  • Providing a false or deliberately misleading statement may lead to a prosecution under Section 307A of the Crimes Act 1900
  • Refer to next page for detailed information on how to complete this form, and evidence needed to support your request
  • If you were not driving your vehicle or you have a 10 year clear driving record contact us to discuss your situation. A form may not be necessary
  • Post your completed form and/or supporting evidence to State Debt Recovery Office, PO BOX 786, Strawberry Hills NSW 2012, or scan and send it online through our Request for Review application at http://www.revenue.nsw.gov.au/contact

Penalty Notice No. 1234567890

Date of offence 17/11/2013

Personal details Mr Mrs Miss Ms Other

Family name Lack

Given name Laura

Postal address 17 Sample Road

Suburb. Lilyfied State. NSW Postcode. 2040

Licence no. 12345678

State of issue NSW

Date of birth 05 04 1972

Email llack@pmail.com

Best contact no. 0444444444

Best time to contact business hours

Note: Please select preferred contact address: Postal Email

To review a penalty notice, we need the authority of the vehicle owner if you are not the person named on the penalty notice or the registered owner of the vehicle. The 'Authority to Act' form is available at http://www.revenue.nsw.gov.au, or by contacting us.

Refer to SDRO Review Guidelines for details of circumstances we can review and evidence required.

Reason for your request:

  • 10-year clear driving record (demerit point offences only) Parking permit (residential/visitor/other)
  • e-TAG/toll offences Rail offence
  • Faulty meter or ticket machine Unregistered/uninsured vehicle/trailer
  • Medical emergency Vehicle breakdown
  • Mobility Parking Scheme Permit Other
  • I am seeking a review of a penalty because: (attach additional pages if necessary)

I left my vehicle for the purpose of obtaining change. I returned with the change, and I confirmed this with the issuing officer (SDR Review Guidelines 1.11).

I intended to pay for the parking but I only had a $10.00 note and the meter would only take coins. I walked to a cafe close to where I had parked and got some change. When I returned, the Ranger was putting a fine on my windscreen. I tried to explain what had happened but he left the fine and walked away.

Attached documentary evidence is:

Signature L.Lack

Date 20/03/2014

Important: See over the page for more information.

How to Request for Review of a Penalty Notice

Important information you need to know

  • Please print clearly in black pen.
  • If you do not provide supporting documents or complete all questions, your application cannot be processed. We are not required to review further if a review has already been conducted.
  • Please do not send a request to have your penalty decided in court if you want us to conduct a review. By law, we must stop a review and issue a Court Attendance Notice if we receive a request to have the penalty decided in court. If the outcome of your review is unfavourable, you have a further 28 days to tell us if you want to dispute the penalty in court.
  • If requesting a review for the same reason for multiple offences, you may include all penalty numbers at the top of the form. Where the reason for requesting a review differs between offences, please complete a separate form for each.
  • Post the completed form, together with documentary evidence, to State Debt Recovery Office, PO Box 786, Strawberry Hills NSW 2012 or scan and email us via http://www.revenue.nsw.gov.au/contact before the due date on the penalty or penalty reminder notice.
  • What happens next? Providing your request was received by the due date on the first penalty reminder notice, do NOT pay the fine. We will place the penalty on hold until we reply. If further evidence is required, you will be provided a further 14 days to supply it. You will be notified in writing of the outcome of your review. If the penalty still applies, you will receive a reminder notice advising your payment options and the due date for payment.

Do NOT use this form if:

  • another person was responsible for the vehicle at the time of the offence. Instead, send us a statutory declaration naming the person in charge of the vehicle. They will have the opportunity to request a review when a new penalty notice is sent to them.
  • you have received an enforcement order for this penalty. Providing the penalty was issued according to law, you can only request a review of an enforcement order if you can prove you were hindered from acting before enforcement. If so, complete the annulment form from http://www.revenue.nsw.gov.au/contact to apply to have the fine decided in court.
  • you have committed a serious offence, such as driving more that 30km/h above the speed limit. If you are seeking leniency for these offences, you would need to present your case in court by submitting an online court election request or returning the court election form from http://www.revenue.nsw.gov.au. The SDRO review guidelines provide further examples of serious driving offences.
  • you cannot pay in full by the due date on the penalty reminder notice and are in receipt of a government benefit, you can avoid extra costs by contacting us or submitting the Early enforcement to pay by instalment form from http://www.revenue.nsw.gov.au before the due date on the penalty reminder notice.
  • you are seeking leniency because you are of 'good character'. We have no authority to review your penalty for this reason.

What evidence do I need to supply to support my request?

For full details of what evidence to supply in support of your claim, refer to the SDRO Review Guidelines.

Some examples include:

  • 10-year clear driving record - just call or write to us if you have a NSW licence and 10 years clear driving record before the offence. If part or all of your traffic history is interstate, obtain a transcript from the interstate authority. Note: We cannot consider your driving record for a non-demerit parking offence. Refer to your reminder notice to
    determine if demerit points apply to your parking offence.
  • valid e-TAG (Toll) - supply the number of your valid etag at the time of offence and Account number.
  • Faulty meter/ticket machine - provide the fault reference number when you phoned to report the meter faulty, the time the machine was used and the method of payment, as well as what happened.
  • Medical emergency - documentary evidence of the incident confirming it was an emergency from a recognised
    medical authority/hospital.
  • valid Mobility Parking Scheme Permit held - copy of both sides of your valid card displayed in the purple Australian permit holder (if it is the first offence only).
  • valid Parking Permit (residential/visitor/other) held - copy of your valid permit, clearly showing the permit number and expiry date.
  • Railcorp ticket offences - copy of valid ticket or concession card at time of offence.
  • Unregistered/uninsured vehicle - proof of registration/insurance.

State Debt Recovery Office contact details

Phone: 1300 138 118
8:00 am - 5:30 pm, Mon. to Fri.
Fax: (02) 4937 9111

Hearing or speech impaired users:
TTY 133 677
Speak and Listen 1300 555 727

Interpreter services:
Phone: 131 450

Postal correspondence only:
State Debt Recovery Office
PO Box 786
Strawberry Hills NSW 2012

Email us via:
http://www.revenue.nsw.gov.au/contact

Mail payments only:
State Debt Recovery Office
PO Box 4444
Parramatta NSW 2124

Refer to your penalty notice for other payment options.

Website:
http://www.revenue.nsw.gov.au

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

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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.