TE9 Witness statement (04.19) © Crown Copyright 2019
Witness statement – unpaid penalty charge
Please complete this form in black ink using BLOCK CAPITALS and return it to the address below
Traffic Enforcement Centre
County Court Business Centre
St. Katharine’s House
21 – 27 St. Katharine’ Street
Northampton, NN1 2LH
Location of Contravention
You must ensure that all details above are correctly entered from the form TE3 - Order for Recovery of
unpaid penalty charge (Parking).
Company name (if vehicle owned
and registered by a company)
The above named witness, declares that:
Tick all boxes that apply to you
Note: If your penalty charge relates to a London Borough Parking Contravention tick only ONE box
I did not receive the Notice to Owner /
Penalty Charge Notice
I appealed against the local authority’s
decision to reject my representation, within
28 days of service of the rejection notice,
but have had no response to my appeal.
I made representations about the penalty
charge to the enforcing authority concerned
within 28 days of the service of the Notice to
Owner, but did not receive a rejection notice.
The penalty charge has been paid in full.
How was it paid
Proceedings for contempt of court may be brought against you if you make or cause to be made
a false statement in an application verified by a statement of truth without an honest belief in its
(I believe) (The witness believes) that the facts stated in this application are true.
(witness) (person signing on behalf of the witness)
If you are signing on behalf of the witness, are you
An officer of
A Litigation friend acting on behalf of a protected party
within the meaning of the Mental Capacity Act 2005