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Statutory Declaration - Unpaid Penalty Charge:), Please Complete This Form in BLOCK CAPITALS and in Black Ink

This document is a statutory declaration form for disputing an unpaid penalty charge notice. It provides instructions for completing the form, which includes providing identifying information about the penalty charge and vehicle. It notes that the form must be sworn before a Commissioner for Oaths, Justice of the Peace, or county court officer. The declarant then checks one of three boxes indicating their reason for disputing the charge, which includes not receiving the original notice, making representations within 28 days that were rejected without response, or appealing a rejection without response. The declarant then provides their full reasons and signs and dates the form before a witness.

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41 views1 page

Statutory Declaration - Unpaid Penalty Charge:), Please Complete This Form in BLOCK CAPITALS and in Black Ink

This document is a statutory declaration form for disputing an unpaid penalty charge notice. It provides instructions for completing the form, which includes providing identifying information about the penalty charge and vehicle. It notes that the form must be sworn before a Commissioner for Oaths, Justice of the Peace, or county court officer. The declarant then checks one of three boxes indicating their reason for disputing the charge, which includes not receiving the original notice, making representations within 28 days that were rejected without response, or appealing a rejection without response. The declarant then provides their full reasons and signs and dates the form before a witness.

Uploaded by

PPainter
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Statutory Declaration – unpaid penalty charge Form PE3

Traffic Enforcement Centre Penalty Charge Number      


County Court Business Centre Vehicle Registration Number      
St Katharine’s House Applicant      
21-27 St Katharine’s Street Location of Contravention      
Northampton, NN1 2LH
Date of Contravention      

Give full details and tick the box which applies. If your penalty charge relates to a London Borough
Parking contravention you must only tick one box. You must ensure that all details above are correctly
entered from the Order for Recovery of unpaid penalty charge.

You must then have the form sworn before a Commissioner for Oaths (e.g. a Solicitor), a Justice of the
Peace (at any Magistrates Court) or an officer of your local county court before sending the declaration
to the Traffic Enforcement Centre at the above address. You may have to pay a fee.

I, (full name and address of the respondent including postcode), please complete this form in BLOCK
CAPITALS and in black ink.
     

The above named respondent, declare that: (tick the box, which applies)

I did not receive the:


Notice to Owner (Parking contravention) or
Enforcement Notice (Bus lane contravention) or
Penalty Charge Notice (Moving Traffic contravention or Congestion Charging contravention)
I made representations about the penalty charge to the local authority concerned within 28 days of
the service of the Notice to Owner/Enforcement Notice/Penalty Charge Notice, but did not receive a
rejection notice.
I appealed to the Parking/Traffic Adjudicator against the local authority’s decision to reject my
representation, within 28 days of service of the rejection notice, but have had no response to my
appeal.

My reasons are (give full reasons)


     

Important: Filing a false declaration knowingly and wilfully is a criminal offence under Section 5 of the
Perjury Act 1911 and you may be imprisoned for up to 2 years or fined or both.

I do solemnly and sincerely declare that the information given here is true.
Signed: Dated:     
Declared at: in the

This day of 20

Before me at*

Commissioner for Oaths/Officer of the Court appointed by the Judge to take affidavits/Justice of the Peace (Please
delete as appropriate)

*The Statutory Declaration will not be accepted without a full postal address
Any amendments to your forms will require them to be re-witnessed

NOTE: If the form is not completed and sworn in accordance with the instructions above it cannot be accepted.
Form PE3 Statutory Declaration unpaid penalty charge (CPR Part 75) (05.14)

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