FER002 Application for Time to Pay Order

Applicant details
OFFICIAL Sensitive Personal
Full name

First NameMiddle NameLast Name
Australian postal address
Date of birth

DayMonthYear
Phone number
Please enter a valid phone number.Format: (61) 0 0000 0000.
Valid mobile phone number format must be (61) 4 1234 5678 or (61) 8 1234 5678 for landline phone number.
Email
Enter a valid email address
Driver’s licence no
Vehicle licence no

Fines and case details
Note: If you want to dispute an infringement in court, you will not be able to do so if your matter is placed on a Time to Pay Order.
Add all my fines
Total amount (if known)
If you have a fine/infringement that you DO NOT want added, list the case number/s:
Was your last Time to Pay Order cancelled due to non-payment?
Note: Any new fines/infringements registered with the Fines Enforcement Registry cannot be automatically included in this order. If you wish to include newly registered matters, you will need to contact the Registry or complete a new application.

Property ownership and home details
Do you own a property?
Australian address
Estimated value
Mortgage value
Home contents
Value of items including furniture, electronics, white goods, tools and collectibles.

Declaration and Acknowledgment
I declare that:

I understand that this is an application only and I should not begin driving until I receive written confirmation from the Registrar that my application has been approved and my licence suspension has been lifted. I may also be subject to other restrictions on my licence and are advised to check the status of your licence with the Department of Transport. To view my infringement(s) and/or court fine(s), make a payment, apply for an order or for more information, visit www.justice.wa.gov.au/fer
Declarant signature
Submission date

MonthDayYear
Hour MinutesAM/PM Option
Should be Empty: