City of Port Phillip

Payment Plan Request

 
This online form is to request a payment plan for your parking infringement
* Denotes that the field is mandatory
Infringement Number (Ticket No) *  
Vehicle Registration *
Full Name *
Mailing Address *
Telephone Number
Email (Acknowledgement of this application for internal review will be sent to this email address) *
Confirm your Email address *
Detail your request for a payment plan
(Please advise whether you are the holder of a Centrelink Health Care Card or Pensioner Concession Card
or a Department of Veterans’ Affairs Pensioner Concessioner Card) *  
Optional Attachment:
Please attach a copy of your Centrelink Health Care Card, Centrelink Pensioner Concession Card or Department of Veterans’ Affairs Pensioner Concessioner Card.
A maximum of three documents may be submitted.
The following file types are accepted: .jpg, .png, .gif, .doc, .docx and .pdf. The maximum file size is 2MB

Privacy


The personal information requested on this application form is being collected by Port Phillip City Council to assist in the assessment of your payment plan or payment arrangement application. The personal information will be used solely by Council for that primary purpose or directly related purposes. Council may disclose this information to VicRoads and Victoria Police. If this information is not collected, Council will be unable to assess your application for a payment plan or payment arrangement. The applicant understands that the personal information provided is for the assessment of the payment plan or payment arrangement application and that he or she may apply to Council for access to and / or amendment of the information. Requests for access and / or amendment should be made to Council’s Governance department.