Application for internal review of an infringement

1Application for internal review of an infringement
2Application summary

Application for internal review of an infringement

Infringement details

EPA infringement number

Infringement recipient

Applicant Details

EPA notice

I am the registered owner/person on the infringement notice
I am an authorised company representative
I am a filling in this form for someone else

I am the person authorised by the notice recipient to apply for an internal review of this fine

Relationship to the Infringement Recipient

Given name

Family name

Job title

Address

Company name

Company ACN

Company address

Email address

By providing an email address you are giving your consent to receive communications from EPA about this matter

Mobile number

Landline number (optional)

Assessment details

What is your reason for requesting an internal review?

Exceptional circumstances
Contrary to law
Special circumstances
Mistaken identity
Person unaware of fine

Reason details

Please provide information to support the reason you have selected

Other information for our consideration (optional)

Is there anything else you would like to tell us?

Upload

Ensure you have uploaded the correct files before clicking "Save and next". Once saved, files can only be removed by submitting a request to EPA. Uploading files is a two step process:

Step 1: Select your files

File properties:

Name	File size

Sensitivity:

Step 2: Upload your files

This type of file can't be uploaded. It must be one of these file types:

This file can't be uploaded. File name must not include following characters: "~", "#", "%", "&", "*", "{", "}", "\", ":", "<", ">", "?", "/", "+", "|", ".."

This file can't be uploaded. File name must not exceed 255 characters.

File has already been uploaded for this application File uploaded successfully