A *colour make model* bearing Victorian registration *registration* is registered in your name. This vehicle was observed at about *time* on *date* at *location*. The driver of the vehicle at this time was *describe driving/offence*.

As a police officer acting in the execution of duty, I am making a demand pursuant to Section 60 of the Road Safety Act 1986 (Vic) for certain particulars to be provided by you as the registered operator.

As the registered operator of the vehicle, you are now legally required by law to nominate who the driver was that drove the vehicle at the time and date I have indicated to you. Failure to comply with this demand consitutes an offence against Section 60(1) of the Road Safety Act 1986 (Vic). If charged and found guilty of this offence, legislated penalties include a fine of up to 20 penalty units, imprisonment for up to 4 months, and the cancellation of any driver licence or permit you hold, with a disqualification period from obtaining a further licence or permit to be determined by the courts.