Document text
Request for Review of a Fine
[YOUR FULL NAME]
[YOUR ADDRESS]
[EMAIL] · [PHONE]
Date of birth: [DATE OF BIRTH]
Driver licence number: [LICENCE NUMBER AND STATE, OR "NONE"]
Revenue NSW
PO Box 786
Strawberry Hills NSW 2012
[DATE]
Sent by: [ONLINE REQUEST REFERENCE … / POST WITH THE REVIEW FORM]
Dear Sir or Madam,
Request for review — fine notice number [FINE NOTICE NUMBER]
Offence: [OFFENCE AS SHOWN ON THE NOTICE]
Date and time of offence: [DATE AND TIME]
Place: [LOCATION]
Vehicle registration: [REGISTRATION, IF ANY]
Due date on the notice: [DUE DATE]
Fine paid: ( ) no ( ) yes, on [DATE PAID]
I ask Revenue NSW to review this fine on the following ground:
( ) Mistake. [EXPLAIN: FOR EXAMPLE, WRONG VEHICLE, I WAS NOT THE DRIVER, THE PARKING METER RECEIPT SHOWS I HAD PAID]
( ) Special circumstances. At the time of the offence [DESCRIBE WHAT WAS HAPPENING, FOR EXAMPLE A MEDICAL EMERGENCY]. Because of this I [COULD NOT UNDERSTAND WHAT I WAS REQUIRED TO DO / COULD NOT CONTROL WHAT HAPPENED].
( ) Clear driving record. I have held a NSW licence for [NUMBER] years with no demerit point offence since [DATE], and this is a lower-risk offence. I ask for a caution.
I ask that the fine be [CANCELLED / REPLACED WITH A CAUTION].
Please put the fine on hold while you review it and send me the outcome in writing to [EMAIL OR POSTAL ADDRESS].
Attached:
[EVIDENCE, FOR EXAMPLE HOSPITAL RECORD OR DOCTOR'S REPORT CONFIRMING DATE AND TIME]
[EVIDENCE]
Copies of identification showing my address, date of birth and licence number
Yours faithfully,
____________________
[YOUR FULL NAME]
For me
[ ] Due date on the notice: [DATE] — send before it
[ ] Already paid: last day to ask is 60 days from the issue date: [DATE]
[ ] Evidence attached (the review uses only what I send)
[ ] Copy kept, proof of sending kept
[ ] Outcome expected about 21 days after receipt; no later than 42 days: [DATE]