Nomination Rejection

Use this form if you have been named as the Known User by the registered owner of the vehicle but you were not the driver or in control of the vehicle/trailer at the time of the offence. You will need to state your reasons for this statement.

First Name

Last Name

Company Name

The name of the company that owns the vehicle. Leave blank if vehicle is privately owned.

Position at company

Your position at the company that owns the vehicle. Leave blank if vehicle is privately owned.

Your Postal Address

Suburb

State

Post Code

Country

Infringement Number

Please separate infringement numbers with a comma. ie 12345,12346,12347...

Agency Name

This is the name of the Council/Hospital/University that issued the infringement. This is never Bartels, Taylor & Associates.

Vehicle Registration Number

Telephone Number

Your email address

IF NOMINATED IN A KNOWN USER STATEMENT

I did not have possession of the motor vehicle

I did not have possession of the motor vehicle or trailer as the case requires, before the offence as stated in the Know User Statement and I did not have possession or control of the motor vehicle or trailer at the time of the offence.

IF NOMINATED IN A SOLD VEHICLE STATEMENT

The motor vehicle or trailer, as the case requires, has not been sold or disposed of to me

The motor vehicle or trailer, as the case requires, has not been sold or disposed of to me, and that no interest in it had otherwise been invested in me as stands in the Sold Vehicle Statement.

I provide the following reasons for my statement

Supporting Evidence and other attachments

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2 GB limit.
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Acknowledgement

I understand and acknowledge that:

This document is a digitally signed statement.
It is an offence to provide false or misleading information and a penalty may be imposed under the relevant acts.

I Agree