Request to have the matter heard in court

Before completing this online form, ensure that:

The matter is still at the Infringement Notice of Penalty Reminder Notice stage.
If you have received a letter from Fines Victoria you will need to contact them directly on (03) 9200 8111

This form contains required fields

Who is making the application?

Person named on the infringement notice

Other representative with written consent

Contact details

Contact details of person making this application.

Email address

Do you consent to being contacted via email?

Yes

Phone

Infringement Notice Number

Your infringement number is located in the top right hand section of the notice

Details of person named on infringement

First name

Surname

Date of offence

DD/MM/YYYY

Company name (if applicable)

Company ACN (if applicable)

Date of Birth

DD/MM/YYYY

Street address

Suburb

State

Postcode

Drivers Licence number

Comments

15,000 characters maximum

Supporting materials

Supporting Evidence Upload

Please upload the required supporting evidence into the file manager box provided below. You may upload up to four (4) files of no more than 10MB per file.

Declaration details

I declare that the information that I have supplied in this form is true and correct to the best of my knowledge.

I accept the terms and conditions stated above. * Required field

Request to have the matter heard in court

Applicant details

There are errors in this form

Consent

Contact details

Details of person named on infringement

Supporting materials

Supporting Evidence Upload

Declaration details