Appendix D

Estoppel Letter – Certificate of Dishonour/Mediation

Date:

From:
First & Second names of the Family
Surname
Address 1
Address 2
IN THE STATE OF [STATE POSTCODE]
To: ORGANIZATION NAME
ADDRESS 1
ADDRESS2
STATE POSTCODE
Officer: Name of person issuing fine
Ph: xxxxxxxxxx
E: mail@mail.com.au
NOTICE
WITH JUST CAUSE AND OR VEXATION:

REFERENCE: Fine reference details printed on the fine notice

ISSUED BY OFFICER ID: [Every officer has an ID or name]
[Title & Name of person issuing fine notice]

To the Interloper Mr/Miss/Mrs [Name] and [OFFICER ID: XXXXX]

Reference: Your letter dated [date]

Notice of Irrevocable Estoppel by Acquiescence

Notice to Agent is Notice to Principal. Notice to Principal is Notice to Agent

 Re: Reference Number: [ACCOUNT NUMBER]

To the Interloper
With reference to the letter dated [LAST LETTER DATE] delivered by recorded mail. In this letter I
asked you to provide the following reasonably requested specific items:
Proof of Claim that the alleged liability in the form of your Offer to Contract was created in the
form of an original contract with me.
Proof of Claim that you and your organization are duly authorized by Crown Authority signed by
Her Majesty Queen Elizabeth the Second, Defender of the Faith, or her assigns, to impose
penalties without establishing your claim through due process in a court of law before twelve of
my peers sitting in a lawfully constituted Jury.
I hereby serve Notice that failure to provide Proof of Claim by [THEIR COMPANY NAME], has
created a permanent and irrevocable estoppel by acquiescence, forevermore barring [THEIR
COMPANY NAME] from bringing any and all claims, legal actions, orders, demands, lawsuits,
costs, levies, penalties, damages, interests, liens and expenses whatsoever, against  ™.

It is important that you acknowledge and understand that this is not a letter but a legal notice,
which is a different species of correspondence all together. I hereby declare that the law of
Agent and Principal shall apply and that service upon one is service upon another.

Furthermore, your failure to provide Proof of Claim in the form of the above reasonably
requested specific items comprises the tacit procuration of [THEIR COMPANY NAME]’s
agreement to the following terms and conditions.
That the debt created by the contract you offered to pay a fine that I did not agree and/or did
not exist in the first place;
OR
It has already been paid in full;
AND
That any damages I suffer, you will be held culpable;
That any negative remarks made to a credit reference agency will be removed;
You will no longer pursue this matter any further.
You have not proven any debt, if you sell the alleged liability, and/or appoint an agent to act on
its/your behalf on this matter you will have broken our agreement and you agree to pay the
following fee schedule 
 Fee Schedule
Any further invalid claims against [my name]™ and/or attempting to contact the Authorised
Representative by mail, mobile phone and/or telephone will constitute the agreement of [THEIR
COMPANY NAME] to the following Fee Schedule:
[INSERT THE FEE SCHEDULE IN APPENDIX E.]
 All fees are payable in Twenty One (21) days of date of invoice is received, as evidenced by
recorded delivery tracking number.

WITHOUT PREJUDICE malice or mischief, in sincerity and honour.

……………………………………………
[First Middle names of the Family
Name]
Only in capacity as Beneficiary of the
original De Jure Jurisdiction, as agent
for [FULL NAME IN CAPS] (and any
and all uppercase derivatives and
variations in the spelling and or
format of said names, including but
not limited to, prefixes, suffixes,
titles, appendages, and the like). All
Rights Reserved, no Loss or Liability
Copies to:
[List the other people
You are sending copies of this
Letter to, one person per line]