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Traffic Offence Contestation Form

This document is a contestation form for a traffic offence involving vehicle license plate LRA34240, attributed to Przemyslaw Mackiewicz. The form requires submission within 7 days to a specified police address or electronically via e-ID. It includes sections for the identity of the vehicle holder, details of the offence, and a declaration of the information's accuracy.

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53 views1 page

Traffic Offence Contestation Form

This document is a contestation form for a traffic offence involving vehicle license plate LRA34240, attributed to Przemyslaw Mackiewicz. The form requires submission within 7 days to a specified police address or electronically via e-ID. It includes sections for the identity of the vehicle holder, details of the offence, and a declaration of the information's accuracy.

Uploaded by

dupaboli1234
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
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Send this form signed within 7 days to Police Report Number AN.95.CW.

901324/2024
Traffic fines, Mailbox 30046, 1000 Brussels System number PPAWP 24CB1098648
or electronically after login using e-ID Print date 19/01/2025

PPAWP-24CB1098648-26995659-D-071
CONTESTATION FORM FOR TRAFFIC OFFENCES
Contestation on person

A. Identity of the current vehicle license plate holder or of the actual driver
Name : Mackiewicz , Przemyslaw
Address : Ul. Radzynska , 85/A
21306 , Czemierniki
Poland
Date and time of the offence : 19/12/2024 03:49
License plate : LRA34240
✗ Citizen Company

B. Question list
1. Is the vehicle with license plate LRA34240 with which the offence was committed, your property or ✗ Yes No
the property of your company?
If no , who is the owner of the vehicle?
Address

2. Were you the driver of the vehicle at the moment of the offence? Yes ✗ No
If no , is the driver of the vehicle at the moment of the offence a company? Yes ✗ No
Coordinates of the driver in case of a company
Company name

Company number

Address

Coordinates of the driver in case of a citizen


Name OGNIK KRZYSZTOF
Nationality & PL-Poland
identification number
Date of birth 13 5 2000
Address POLNA 36B/6

21-200 PARCZEW Poland

✗ 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:

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