A unique number identifying this fixed penalty notice within the authority.

### APPENDIX A – NRSWA Fixed Penalty Notice

* (* Insert Road Works Authority name )	FIXED PENALTY NOTICE NEW ROADS AND STREET WORKS ACT 1991 / (Section 154A and Schedules 6A and 6B)	FIXED PENALTY NOTICE Number: …………… …….
PART A
Contact Tel No.	Works Ref No. * SRWR Road Works Authority No. * (*To be left blank where the offence relates to works in respect of which no notice has been given.)
TO:	DATE OF THIS NOTICE: …………….. (dd/mm/yy)
ADDRESS: Undertakers are asked to provide, where possible, an electronic address as well as the postal address. If the undertaker fails to provide a postal address then the fixed penalty notice should be served in accordance with the options set out in the regulations. are asked to provide, where possible, an electronic address as well as the postal address. If the undertaker fails to provide a postal address then the fixed penalty notice should be served in accordance with the options set out in the regulations.
OFFENCE CODE: (See Part B) (NB: Only one offence code per fixed penalty notice)
LOCATION: (including USRN) Insert relevant offence code from Part B code from Part B relevant offence code	Insert relevant offence code from Part B code from Part B
DETAILS AND DATE OF OFFENCE: This box needs to specify reasonable particulars of the circumstances alleged to constitute the offence and should be expanded if required. box needs to specify reasonable particulars of the circumstances alleged to constitute the offence and should be expanded if required.
1. I am giving you this notice, further to section 154A, Schedule 6B to the New Roads and Street Works Act 1991, to offer you the opportunity of discharging any liability to conviction for this offence by payment of a fixed penalty. 2. This means that no legal proceedings will be commenced for the offence if, subject to paragraph 3, the fixed penalty of £120 is paid (See Part B) within the period of 36 days beginning with the date of this notice. 3. Instead of paying the amount referred to in paragraph 2, liability to conviction for the offence may also be discharged if the discounted amount of £80 is paid within the period of 29 days beginning with the date of this notice. (NB: If the last day of this period does not fall on a working day, the period for payment of the discounted amount is extended until the end of the next working day (See Paragraph 5(3) of Schedule 6B )). 4. If the discounted amount is not paid within the period set out in paragraph 3, as extended where relevant, liability to conviction for the offence may only be discharged thereafter by payment of the fixed penalty within the period set out in paragraph 2. Should you then fail to pay the fixed penalty within that period, legal proceedings for the offence may be commenced against you. 5. Any representations that you wish to make in relation to this notice may be addressed to at identifying the fixed penalty notice number stated above.
NAME OF AUTHORISED OFFICER (in block capitals): (in block capitals): …………………………………………….	OFFICER (in block capitals):
T h e s e s h o u l d b e d if f e r e n t o f f i c e r s T h e s e s h o u l d b e d if f e r e n t o f f i c e r s h e s e s h o u l d b e d if f e r e n t o f f i c e r s Representations in writing should be made to this officer. The Authority should provide full contact details. in writing should be made to this officer. The Authority should ……………………………………………. provide full contact details.

Undertakers are asked to provide, where possible, an electronic address as well as the postal address. If the undertaker fails to provide a postal address then the fixed penalty notice should be served in accordance with the options set out in the regulations.

Insert relevant offence code from Part B

This box needs to specify reasonable particulars of the circumstances alleged to constitute the offence and should be expanded if required.

T h e s e s h o u l d b e d if f e r e n t o f f i c e r s

Representations in writing should be made to this officer. The Authority should provide full contact details.

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