Schedule 3 Notice to withdraw infringement notice – The following is an extract from the Health (Asbestos) Regulations 1992. This is a prescribed form. Health (Miscellaneous Provisions) Act 1911 Health (Asbestos) Regulations 1992 Infringement notice no. WITHDRAWAL OF INFRINGEMENT NOTICE Name Alleged offender Address Infringement Details of notice no. infringement notice Date of Date or period Place Details of alleged Written law Health (Asbestos) Regulations 1992 regulation offence contravened Details of offence Name Approved Officer Office withdrawing Signature notice Date of Date withdrawal The above infringement notice issued against you for the alleged offence has been withdrawn. If you have already paid the modified penalty for the alleged offence, you are entitled to a refund. Withdrawal if * Your refund is enclosed. infringement notice or * If you have paid the modified penalty but a refund is not enclosed, [*Delete you may claim your refund by signing and dating this notice and whichever is posting it to: not applicable] Approved Officer Health (Asbestos) Regulations 1992 – [Address] Your Signature Date
Schedule 3 – Notice to withdraw infringement notice The following is an extract from the Health (Asbestos) Regulations 1992. This is a prescribed form. Health (Miscellaneous Provisions) Act 1911 Health (Asbestos) Regulations 1992 WITHDRAWAL OF INFRINGEMENT NOTICE Infringement notice no. Alleged offender Name Address Details of infringement notice Infringement notice no. Date of Details of alleged offence Date or period Place Written law contravened Health (Asbestos) Regulations 1992 regulation Details of offence Approved Officer withdrawing notice Name Office Signature Date Date of withdrawal Withdrawal if infringement notice [*Delete whichever is not applicable] The above infringement notice issued against you for the alleged offence has been withdrawn. If you have already paid the modified penalty for the alleged offence, you are entitled to a refund. * Your refund is enclosed. or * If you have paid the modified penalty but a refund is not enclosed, you may claim your refund by signing and dating this notice and posting it to: Approved Officer – Health (Asbestos) Regulations 1992 [Address] Your Signature Date
Schedule%203%20-%20Notice%20to%20withdraw%20infringement%20notice.docx