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Only use this form if no more than 28 days have passed since you paid to have your vehicle released.
* Required field
* Penalty Charge Notice (PCN) (example KE12345678):
* Vehicle Registration (example X123XXX):
* First Name:
* Post Code:
* I am: [Please select one from the list]The DriverThe KeeperThe Driver & KeeperNeither
* Date paid for the release:representation has to be made within 28 days of payment.
Please read the following eight grounds and write the corresponding letter in the box below. Please continue in the box giving full details of your representation.
Vehicle immobilisation (Clamp) or Removal:
Additional ground applicable to Removal only:
Additional ground applicable to Vehicle immobilisation (Clamp) only:
* Why are you making a formal representation against the clamping or removal of your vehicle? Please state your grounds followed by your reasons for making this representation.e.g. B. My reason...
This form is unable to accept attachments or photos, if you wish to include these
as part of your representation please forward separately either by e-mail to
firstname.lastname@example.org or by post to "RBKC, PO Box 4294, Worthing, BN13 1WW"
quoting your penalty charge notice number.
Any information you provide will be used by the Council for the purpose of dealing
with this report and will not be disclosed to the public. This information may be
provided to organisations working on behalf of the Council to rectify the problem.
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