Road Traffic Regulation Act 1984 (as amended)
London Local Authorities Act 1996 (as amended)
Date: [Issue date]
Penalty Charge Notice No: [PCN number]
Date of contravention: [Contravention date]
Location of contravention: [Contravention location]
We sent you an Enforcement Notice on [Notice issue date] which explained that as the person we believe is the owner of the vehicle, registration number [VRM], you had to pay a penalty charge, or write to us explaining why you believed you did not have to pay it.
We are now sending you this charge certificate because (include as appropriate) you did not respond to the Enforcement Notice / you wrote to us but we did not accept your reasons for not having to pay the penalty charge and you did not then appeal to the adjudicator/ you appealed to the adjudicator but your appeal was rejected, and the charge has not been paid.
As a result, the penalty charge has now increased by 50% to £[full amount + 50%].
You must pay this increased amount before the end of the period of 14 days, beginning with the date this certificate was served (the date it was delivered). See overleaf for details of how to pay.
If we do not receive payment before the end of the 14 day period, we may register the charge as a debt at the county court and ultimately we may pass the case to bailiffs to recover the debt.
We strongly advise you to deal with this matter now as if it is passed to bailiffs they will add their costs, which will significantly increase the amount that will need to be paid.
If you have any questions about this charge certificate, please telephone our helpline on
[Helpline phone number]
Owner Name
Owner Address 1
Owner Address 2
Owner Address 3
Town
Postcode
London
HOW TO PAY
Please make cheques and postal orders payable to “[Payee details]” and write the penalty charge notice number on the back. Please do not send post-dated cheques as they will not be accepted.
If you want to pay by post, please fill in the payment slip at the bottom of this page and send it with your payment or card payment authorisation to: [Payment address]
If you want a receipt, please enclose a stamped addressed envelope.
Please do not send cash through the post.
If you want to pay in person, , please go to [Payment centre address] between [Times] on [Days]
If you pay by cash it is very important to get a receipt, in case there is any later query about your payment.
Or you can pay by telephone on [Payment phone number] between [Times] on [Days] using one of the following debit or credit cards – [List of accepted cards].
Payment slip – please return with all payments sent by post
Penalty Charge Notice Number: [PCN number] VRM: [VRM]
issued in: [Contravention location] at: [End time] on: [Contravention date]
Mr/Mrs/Ms/Miss: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Only complete the details below if you are making payment by MASTERCARD, VISA, SWITCH or DELTA card.
Please debit my MasterCard / Visa / Switch / Delta card (delete as appropriate) Amount £ _ _ _ _ _ _ _
Card Number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ _ _ _ (Switch 19 numbers) Switch Issue Number: _ _ _ _
Card Issue Date _ _ / _ _ Card Expiry Date _ _ / _ _ Name of Cardholder: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature of Cardholder: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _