City of Gold Coast | Penalty Infringement Notice (PIN) withdrawal request

Penalty Infringement Notice (PIN) withdrawal request

The person making application should be the person issued with the PIN (the 'affected person').

Please refer to the Council of the City of Gold Coast (Council) PIN Review Policy, Section 4, for details of who can make a request.

Privacy Statement

Council of the City of Gold Coast (Council) is collecting your personal information in accordance with Local Government Act 2009 in order to assess your request. The information will only be used by authorised officers for the purpose of assessing your request. Your information will not be given to any other person or agency unless you have given us permission or we are required or allowed to by law.

Fields marked with an asterisk * are mandatory fields.

Applicant name
 
 
 
Contact details
 
PIN details
 
     
 
 
Grounds for request

Please refer to Attachment B of Council's PIN Review Policy to view the circumstances where Council may consider the withdrawal of a PIN.

Please refer to Attachment C of Council's PIN Review Policy to view the circumstances where Council will typically not consider the withdrawal of a PIN.

Please select the grounds for the request:

 

1. Elements of offence not met

If it is believed the facts concerning the alleged offence are incorrect, or the details have been incorrectly recorded on the PIN, then the basis for making this claim is to be provided and explained. All relevant or supporting evidence is to be attached.



2. Incorrect name

A Statutory Declaration is to be provided with the name and address of the person in control of the land/vehicle; copy of disposal notice; and/or police report attached (whichever is applicable).



3. Other reason

Details are to be provided outlining circumstances of why committing an offence was unavoidable. Copies of supporting documentation (e.g. medical certificate, towing invoice, valid permits) are to be attached along with a Statutory Declaration form where applicable.



Applicant declaration

I understand and acknowledge that:

  • The information provided in this application is true and complete to the best of my knowledge.
  • The Council of the City of Gold Coast may refuse this request if it becomes evident that any information or supporting documents provided is incomplete or false.
  • I approve of the information that has been provided in this application.
  • I acknowledge Queensland State Laws will accept this communication as containing my signature within the meaning of the Electronic Transactions (Queensland) Act 2001.
 

Date:

ADVERTISEMENT

Top of page Top of page