Sch 9Form of withdrawal notice

Schedule 9 — Form of withdrawal notice

[r. 302(2)]

• Firearms Act 2024Withdrawal of infringement notice Withdrawal of infringement notice no.
• Alleged offender Surname
• Given names
• Date of birth
• Address
• Firearm authority details Type
• No.
• Expiry (if applicable)
• Infringement notice Infringement notice no.
• Date of issue / /20
• Alleged offence Description of offence
• Provision contravened
• Date / /20
• Time
• Place
• Approved officer withdrawing notice Name
• Office held
• Signature
• Registered number
• Police station/squad
• Date of withdrawal / /20
• Withdrawal of infringement notice The above infringement notice, which was issued for the above alleged offence, has been withdrawn.If you have already paid the modified penalty for the alleged offence in accordance with the infringement notice, the amount will be refunded to you.