Infringement Advice Form

Form completion: 0%

Contact Details

Details of person requesting advice (this is our client)

Salutation:

First name:

Middle name/s:

Last name:

Contact number:

Email address:

Is the person requesting advice the person named on the infringement notice?

Infringement Details

Are you seeking advice on one infringement notice or more than one infringement notice?

Infringement 1

Have you paid the infringement?

Infringement due date:

Infringement Number:

Vehicle Plate Number:

Have you requested the DOT to review the infringement notice?

Have you elected to have the infringement determined by a Court?

Circumstances when Photograph was Taken

The individual named in the infringement notice was:

Does the infringement notice allege the driver, or the passenger, was not wearing a seatbelt?

At the time the photograph was taken was the vehicle:

Was the person captured in the photograph wearing a seatbelt? (select the answer that closest matches the circumstances)

Infringement 2

Have you paid the infringement?

Infringement due date:

Infringement Number:

Vehicle Plate Number:

Have you requested the DOT to review the infringement notice?

Have you elected to have the infringement determined by a Court?

Circumstances when Photograph was Taken

The individual named in the infringement notice was:

Does the infringement notice allege the driver, or the passenger, was not wearing a seatbelt?

At the time the photograph was taken was the vehicle:

Was the person captured in the photograph wearing a seatbelt? (select the answer that closest matches the circumstances)

Infringement 3

Have you paid the infringement?

Infringement due date:

Infringement Number:

Vehicle Plate Number:

Have you requested the DOT to review the infringement notice?

Have you elected to have the infringement determined by a Court?

Circumstances when Photograph was Taken

The individual named in the infringement notice was:

Does the infringement notice allege the driver, or the passenger, was not wearing a seatbelt?

At the time the photograph was taken was the vehicle:

Was the person captured in the photograph wearing a seatbelt? (select the answer that closest matches the circumstances)

Review Type

What type of case review do you want?

Infringement Advice Form

Contact Details

Infringement Details

Court Details

Review Type

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