Penalty Charge Notice (PCN) Challenge Form

This form should be used to challenge a Penalty Charge Notice issued less than 28 days ago. Your postal address must be supplied in order for us to respond. Your case will be held while we investigate your concerns and a reply will be sent to you telling you what to do next.

Penalty Charge Notice No. *

Date of Issue

Vehicle Registration *

Your Full Name *

Your Full Address *

Email Address * Help

Daytime Telephone No.

Registered Keeper of the vehicle (if different):

Keeper's Full Name

Keeper's Full Address

Briefly explain what happened and why you feel you should not have to pay this penalty charge *

Data Protection Act 1998

For the purposes of the Data Protection Act 1998, the Data Controller in relation to any personal data supplied is Ipswich Borough Council.

I understand that the information provided on this form will be processed and stored in accordance with the principles of the Act for the purposes of reviewing Penalty Charge Notices.

Please tick *