Payment Arrangement Application Form

A payment arrangement is an agreement you make with Fines Victoria that gives you more time to pay your fines. A payment arrangement can allow you to pay your fine in instalments.

You can only request for infringement notices issued in your name to be referred to Fines Victoria for a payment arrangement. If the infringement notice is not in your name, you will need to ask the registered owner to nominate you as the driver.

If you would like to proceed with your application, please complete the form below:

A payment arrangement is an agreement you make with Fines Victoria that gives you more time to pay your fines. A payment arrangement can allow you to pay your fine in instalments.

You can only request for infringement notices issued in your name to be referred to Fines Victoria for a payment arrangement. If the infringement notice is not in your name, you will need to ask the registered owner to nominate you as the driver.

If you would like to proceed with your application, please complete the form below:

Your first name

Your surname

Your street address

Your suburb and postcode

Your contact number

Your email address

Infringement details

Infringement Number and Vehicle Registration (vehicle registration for parking fines only)

Do you authorise Merri-bek City Council to forward your details onto Fines Victoria in order to set up a payment arrangement.

Yes, I authorise Merri-bek City Council to forward my details onto Fines Victoria in order to set up a payment arrangement.

Do you declare that the information contained in this written statement is true and correct.

Yes. I declare that the information contained in this written statement is true and correct.

Signature (please type your full name)

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