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Mr John Smith

[Date] Street
Suburb
State 3000
[Name of person to object to]
C/o- Civic Compliance Victoria
P.O. Box 1916R
Melbourne
Victoria 3001

Notice of Objection
Infringement Notice Number 0123456789
My reasons for holding that there has been no offence committed under the Road Safety
Act 1986 were clearly stated in my correspondence of the [insert date of your letter for an
Internal Review].
I object to the infringement notice and imposition of penalties. In the event that further
action is to be undertaken, then I require it be dealt with in Law by a Court of Competent
Jurisdiction of Australia.

[John Smith]

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