Transportation Appeal Tribunal of Canada Certificate Regulations (SOR/2004-130)

In the matter of the contravention of (specify designated provision) on (specify date) by (identify contravener)

Having reviewed the materials submitted by the Minister and having verified that no request for a review was filed with the Tribunal, it is hereby certified that:

a monetary penalty in the amount of $(specify amount) was assessed by way of notice:

(tick the correct box)

• ☐ served on (identify contravener) by personal service on (specify date), or

• ☐ sent to (identify contravener) by registered or certified mail on (specify date);

(identify contravener) failed to pay the amount of the monetary penalty and did not file a request for review within the time specified in the notice, being on or before (specify date); and (identify contravener) is deemed to have committed the contravention alleged in the notice, and the amount of $(specify amount) specified in the notice is outstanding.

Dated this day of , 20

Signed by: Name of Chairperson or Vice-chairperson of Tribunal

Address of Tribunal