Application to file a statutory declaration out of time

Published date21 March 2018
Subject MatterTraffic Enforcement Centre forms
Statutory Declaration – unpaid penalty charge

Application to file a Statutory Declaration Out of Time Form PE2

Traffic Enforcement Centre

St Katharine’s House

21-27 St Katharine’s Street

Northampton, NN1 2LH

Penalty Charge Number

Vehicle Registration Number

Applicant

Location of Contravention

Date of Contravention

This declaration must be 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. Please complete this form in BLOCK CAPITALS and in black ink.

I, (full name and address of the respondent including postcode)

The above named respondent, apply for leave to file a Statutory Declaration out of time.

My reasons for filing the Statutory Declaration outside the given time are as follows:

(Do not give your reasons for appeal against the original penalty charge on this form).

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...

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