Online Form - Infringement Appeal Form

If you wish to dispute a fine, you must submit an appeal in writing and return it to the Town by:

Email: town@cottesloe.wa.gov.au
Post: Chief Executive Officer, Town of Cottesloe, PO Box 606, Cottesloe, 6911
Completing the form below

Appeals cannot be received over the phone.

Please ensure that you have read the information provided on the 'Appeals' page of what constitutes a valid appeal. If you are not the owner of the infringed vehicle, the appeal requires the owner to complete a statutory declaration nominating the driver.

If the appeal is submitted correctly, a confirmation message will appear on your screen and an appeal acknowledgment letter will be sent to your provided property address within 10 business days. If you do not receive an acknowledgement of your appeal, please contact the Town on 9285 5000.

Name of driver *

Residential address of driver *

Postal address of driver *

Phone number

Email address *

Date of birth of driver *

Drivers Licence Number of driver

Vehicle registration number *

Are you the owner of the vehicle? *

YesNo

If no, please provide vehicle owners details (name, date of birth, postal address, driver's license number)

If you are not the vehicle owner, please upload a statutory declaration from the owner to confirm that the details of the driver are true and complete

Maximum size of ALL attachments is 976.56 MB

Infringement number *

Date of infringement *

Please enter the details of your appeal *

Supporting evidence

Maximum size of ALL attachments is 976.56 MB

I declare that the above information is, to the best of my knowledge, true and correct. I understand that it is an offence to give a false statement or one which is intended to mislead. *

Yes

Signature *

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