Witness Statement - Unpaid Penalty Charge
| Published date | 21 March 2018 |
| Subject Matter | Traffic Enforcement Centre forms |
Form TE9
Witness statement – unpaid penalty charge
Trafc Enforcement Centre
Northampton County Court Business Centre
St. Katharine’s House
21 – 27 St Katharine’s Street
Northampton, NN1 2LH
Penalty Charge No.
Vehicle Registration No.
Applicant
Location of Contravention
Date of Contravention
You must ensure that all details above are correctly entered from the form TE3 - Order for Recovery of unpaid
penalty charge (Dart Charge or Mersey Gateway).
Full name (Witness)
Address
Postcode
The above named witness, declares that: Tick all boxes that apply to you.
I did not receive the penalty charge notice.
I made representations about the penalty charge to
the Charging Authority concerned, within 28 days
of the service of the Penalty Charge Notice, but did
not receive a rejection notice.
Proceedings for contempt of court may be brought against you if you make or cause to be made a false
statement in an application veried by a statement of truth without an honest belief in its truth.
TE9 Witness statement - unpaid penalty charge (Parking) (09.20) © Crown Copyright 2020
Title Mr. Mrs. Miss Ms. Other
Please complete this form in black ink using BLOCK CAPITALS and return it to the address below
Company name (If vehicle owned and
registered by a company)
The penalty charge has been paid in full.
Date it was paid
How was it paid Cash/Cheque/Debit/Credit card
To whom was it paid
Statement of truth
(I believe) (The witness believes) that the facts stated in this statement are true.
Print full name
Signed Dated
(witness) (Person signing on behalf of witness)
If you are signing on behalf of the witness, are you
An Ofcer of
the company
A Partner
of the rm
A Litigation friend acting on behalf of a protected party
within the meaning of the Mental Capacity Act 2005
I appealed to an adjudicator against the Charging
Authority's decision to reject my representation,
within 28 days of service of the Rejection notice,
but have either:
Had no response to the appeal,or
The appeal had not been determined by the time
that the charge certicate had been served,or
The appeal was determined in my favour.
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