Scribd
Upload
701 views1 page

PPBXL 22F41520 15910121 D 072 PDF

This document is a contestation form for a traffic offense submitted to the police. It identifies Poruchin Consulting as the current license plate holder of vehicle 2CAK760, which was recorded committing a traffic offense on May 6, 2022 at 8:51. The form confirms that Poruchin Consulting owns the vehicle and that the driver at the time was Michail Poruchin of Rue Massaux 2, 1030 Schaerbeek, Belgium. The submitter declares the information provided is complete and correct.

Uploaded by

Michaël Paradjian
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
701 views1 page

PPBXL 22F41520 15910121 D 072 PDF

This document is a contestation form for a traffic offense submitted to the police. It identifies Poruchin Consulting as the current license plate holder of vehicle 2CAK760, which was recorded committing a traffic offense on May 6, 2022 at 8:51. The form confirms that Poruchin Consulting owns the vehicle and that the driver at the time was Michail Poruchin of Rue Massaux 2, 1030 Schaerbeek, Belgium. The submitter declares the information provided is complete and correct.

Uploaded by

Michaël Paradjian
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Send this form signed within 7 days to Police Report Number BR.99.L6.

350522/2022
Traffic fines, Mailbox 30046, 1000 Brussels System number PPBXL 22F41520
or electronically after login using e-ID Print date 04/09/2022

PPBXL-22F41520-15910121-D-072
CONTESTATION FORM FOR TRAFFIC OFFENCES
Identification of the driver - legal person

A. Identity of the current vehicle license plate holder or of the actual driver
Name : PORUCHIN CONSULTING ,
Address : Rue Massaux , 2
1030 , Schaerbeek
Belgium
Date and time of the offence : 05/06/2022 08:51
License plate : 2CAK760
Citizen ✗ Company

B. Question list
1. Is the vehicle with license plate 2CAK760 with which the offence is committed, your property? ✗ Yes No
If no , who is the owner of the vehicle?
Name

Address

2. Do you know the identity of the person who was driving the vehicle at the moment of the offence ✗ Yes No

Coordinates of the person or company responsible for the vehicle


Company name

Company number

Address

Coordinates of the driver in case of a citizen


Name PORUCHIN Michail
Belgian national register
number
Date of birth 17 1 1983
Address RUE MASSAUX 2

1030 SCHAERBEEK Belgium

✗ I declare that the above information is complete and correct.

If you send the form by post: do not change your answers once the form is printed.
Changes to the content applied after printing will not be considered.

Date: . . / . . / . . . .
Name:
Signature:

You might also like