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1 Penalty Fare Notices Name Date pad started / / Commencing Notice Number Authorised Collector Number Date pad finished / / Last Issue Notice Number Notes For The Guidance Of Authorised Collector Issuing Penalty Fare Notices 1. Ensure that pad is intact when received. 2. Notice must be issued consecutively. Black ballpoint pen and block capitals to be used. 3. Notices are carbonised and do NOT require carbon paper. Ensure that leaf of book is placed under the last copy of the notice being issued. Always check that the writing has carbonised on to all copies of the notice being issued. 4. Station names to be shown in full. 5. Alterations must not, in any circumstances, appear on notices issued to passengers. If an error should occur in preparing a notice or notices become defaced, another notice must be made out. Both original and counterfoils of the notice on which the error appears must be endorsed CANCELLED on all copies and the reason for the cancellation notice thereon. 6. All monies collected must be paid in daily, and pads kept securely in accordance with local instructions. 7. Distribution on Penalty Fare Notices: Copy 1 - Prosecutions Office - Pink Copy 2 - Hand to Passenger - White Copy 3 - Retain in Book - Yellow

2 Penalty Fare Notice Issued for travel within East Midlands Trains Penalty Fare area ONLY Date / / (DD) (MTH) (YY) 1. Penalty Fare Notice / Receipt _ (Not Transferable) At : hrs, having travelled and failed to produce a valid ticket or other authority to travel for your journey, you are required to pay: PENALTY of 20 OR twice the appropriate full single fare, whichever is the greater from to_ (insert station stop) Class Standard First Issued On Train At Station Reason 00 No ticket 01 Standard to First 02 Out of Date Travel 03 Travel Beyond Validity 04 No Supporting Documentation 05 Adult on Child Ticket 06 Other (reason) 07 Failed to Carry Season Ticket 08 Oyster Card 09 Freedom Pass OR At : hrs, being in compulsory ticket area and not having travelled at Total Due Amount Received Amount Owing The Penalty Fare Notice / Receipt is given in accordance with the Penalty Fare Rules 2002 and is an authority to finish the journey detailed above without break of journey and / or to leave a compulsory ticket area. Authorised Collector Number Staff Signature Any additional correspondence / reminders from East Midlands Trains Limited or its agents may incur additional administration costs if payment is not received within 21 days of issue of this notice. Please quote your unique reference number on all correspondence. For details of how to pay or appeal, please see reverse. 2. Date of Birth Name of parent or guardian (if under 18) Mr Mrs Ms Other Surname Forenames Number / House Name Street District Town County Postcode Telephone Number Address NI Number Name Verifi ed Address Verifi ed Reference IMPORTANT NOTICE Unless the amount owing is paid in full by 21 days from date shown at the top of this notice, legal proceedings may be brought against you for non payment. If you wish to dispute your liability to pay a Penalty Fare, a statement giving an explanation of your failure to produce a valid ticket or other authority for your journey, together with any information as to your journey referred to in that explanation, must be made in writing and sent to the Appeals address on the reverse so as to arrive no later than 21 days from the date shown at the top of this notice. Copies of the rules may be obtained from eastmidlandstrains.co.uk. A summary of the operator s approved Penalty Fare Scheme may be obtained from East Midlands Trains. I confi rm the personal and journey details given are correct. I have been informed of the appeals procedure and understand that I have until 21 days from the date shown at the top of this notice to fi nalise this matter. (Customer Signature) Please forward this document with any correspondence or payment (see reverse). Appeals are accepted in writing only. Pink - Prosecutions Copy White - Customer Copy Yellow - Retain in Book

3 Description Build Hair Colour Heavy / Medium / Small / Slight / Thin / Broad / Proportionate / Stocky Black / Dark Brown / Light Brown / Fair / White / Blonde / Ginger / Auburn / Grey / Brown / Red / Sandy / Mousy / Dyed Hair Type Eye Colour Ethnic Appearance Facial Hair Height Other Factors Occupation Bald / Receding / Cropped / Short / Collar Length / Shoulder Length / Long Straight / Curly Brown / Blue / Green / Grey / Albino / Other White European / Dark European / Afro Caribbean / Asian / Middle Eastern / Unknown Other Full Beard / Moustache / Goatee / Extended Sideburns / Clean Shaven / Stubble Other Left / Right Handed Glasses Y / N Jewellery Marks / Scars Tattoos Complexion Brief Events (for All Nil Payments)

4 Penalty Fare Notice Issued for travel within East Midlands Trains Penalty Fare area ONLY Date / / (DD) (MTH) (YY) 1. Penalty Fare Notice / Receipt _ (Not Transferable) At : hrs, having travelled and failed to produce a valid ticket or other authority to travel for your journey, you are required to pay: PENALTY of 20 OR twice the appropriate full single fare, whichever is the greater from to_ (insert station stop) Class Standard First Issued On Train At Station Reason 00 No ticket 01 Standard to First 02 Out of Date Travel 03 Travel Beyond Validity 04 No Supporting Documentation 05 Adult on Child Ticket 06 Other (reason) 07 Failed to Carry Season Ticket 08 Oyster Card 09 Freedom Pass OR At : hrs, being in compulsory ticket area and not having travelled at Total Due Amount Received Amount Owing The Penalty Fare Notice / Receipt is given in accordance with the Penalty Fare Rules 2002 and is an authority to finish the journey detailed above without break of journey and / or to leave a compulsory ticket area. Authorised Collector Number Staff Signature Any additional correspondence / reminders from East Midlands Trains Limited or its agents may incur additional administration costs if payment is not received within 21 days of issue of this notice. Please quote your unique reference number on all correspondence. For details of how to pay or appeal, please see reverse. 2. Date of Birth Name of parent or guardian (if under 18) Mr Mrs Ms Other Surname Forenames Number / House Name Street District Town County Postcode Telephone Number Address NI Number Name Verifi ed Address Verifi ed Reference IMPORTANT NOTICE Unless the amount owing is paid in full by 21 days from date shown at the top of this notice, legal proceedings may be brought against you for non payment. If you wish to dispute your liability to pay a Penalty Fare, a statement giving an explanation of your failure to produce a valid ticket or other authority for your journey, together with any information as to your journey referred to in that explanation, must be made in writing and sent to the Appeals address on the reverse so as to arrive no later than 21 days from the date shown at the top of this notice. Copies of the rules may be obtained from eastmidlandstrains.co.uk. A summary of the operator s approved Penalty Fare Scheme may be obtained from East Midlands Trains. I confi rm the personal and journey details given are correct. I have been informed of the appeals procedure and understand that I have until 21 days from the date shown at the top of this notice to fi nalise this matter. (Customer Signature) Please forward this document with any correspondence or payment (see reverse). Appeals are accepted in writing only. Pink - Prosecutions Copy White - Customer Copy Yellow - Retain in Book

5 What to do if you are given a Penalty Fare Notice You must either pay the amount due, or appeal against the notice. You must do this within 21 days. Administration Fees If you have not paid or appealed within 21 days, then an Adminstration Fee will be added to the amount due. This will happen each time we have to contact you to request payment. How to Appeal Appeals must be in writing, and cannot be made by telephone. You should enclose a copy of this notice and explain why you did not produce a valid ticket or another authority to travel, and provide any further information you have to support your explanation. You should include details of the time and place where your journey began, and the time and place where your journey ended. You can appeal online at penaltyfares.co.uk, or you can download a form to return by fax or post. Alternatively you can write to Independent Penalty Fares Appeals Service (IPFAS), PO Box 30, Portsmouth PO1 1ER. The following are unlikely to be accepted as grounds for appeal: Lost ticket, No money, Train was in the station, In a hurry or Forgot to validate. What will happen if you do not pay If you do not pay the outstanding balance in full, then further action is likely to pursue the debt. This may be through prosecution in the criminal courts. Further information You can find more information about Penalty Fares, Unpaid Fares and appeals and payments at the website eastmidlandstrains.co.uk. How to Pay Cheques should be made payable to East Midlands Trains and must be endorsed on the reverse with your name, address and reference number. The notice and payment should be sent to East Midlands Trains, Revenue Protection Office, Nottingham Station, Carrington Street, Nottingham NG2 3AQ. If you require a receipt please enclose a stamped addressed envelope. Alternatively payment can be made using your credit or debit card by telephoning If you wish to make any comments about the service you have received, please contact us at: Customer Relations East Midlands Trains 1 Prospect Place, Millennium Way Pride Park, Derby DE24 8HG Telephone:

6 Penalty Fare Notice Issued for travel within East Midlands Trains Penalty Fare area ONLY Date / / (DD) (MTH) (YY) 1. Penalty Fare Notice / Receipt _ (Not Transferable) At : hrs, having travelled and failed to produce a valid ticket or other authority to travel for your journey, you are required to pay: PENALTY of 20 OR twice the appropriate full single fare, whichever is the greater from to_ (insert station stop) Class Standard First Issued On Train At Station Reason 00 No ticket 01 Standard to First 02 Out of Date Travel 03 Travel Beyond Validity 04 No Supporting Documentation 05 Adult on Child Ticket 06 Other (reason) 07 Failed to Carry Season Ticket 08 Oyster Card 09 Freedom Pass OR At : hrs, being in compulsory ticket area and not having travelled at Total Due Amount Received Amount Owing The Penalty Fare Notice / Receipt is given in accordance with the Penalty Fare Rules 2002 and is an authority to finish the journey detailed above without break of journey and / or to leave a compulsory ticket area. Authorised Collector Number Staff Signature Any additional correspondence / reminders from East Midlands Trains Limited or its agents may incur additional administration costs if payment is not received within 21 days of issue of this notice. Please quote your unique reference number on all correspondence. For details of how to pay or appeal, please see reverse. 2. Date of Birth Name of parent or guardian (if under 18) Mr Mrs Ms Other Surname Forenames Number / House Name Street District Town County Postcode Telephone Number Address NI Number Name Verifi ed Address Verifi ed Reference IMPORTANT NOTICE Unless the amount owing is paid in full by 21 days from date shown at the top of this notice, legal proceedings may be brought against you for non payment. If you wish to dispute your liability to pay a Penalty Fare, a statement giving an explanation of your failure to produce a valid ticket or other authority for your journey, together with any information as to your journey referred to in that explanation, must be made in writing and sent to the Appeals address on the reverse so as to arrive no later than 21 days from the date shown at the top of this notice. Copies of the rules may be obtained from eastmidlandstrains.co.uk. A summary of the operator s approved Penalty Fare Scheme may be obtained from East Midlands Trains. I confi rm the personal and journey details given are correct. I have been informed of the appeals procedure and understand that I have until 21 days from the date shown at the top of this notice to fi nalise this matter. (Customer Signature) Please forward this document with any correspondence or payment (see reverse). Appeals are accepted in writing only. Pink - Prosecutions Copy White - Customer Copy Yellow - Retain in Book

Seafarer certificate application form

Seafarer certificate application form Last updated: 9 December 2016. This document is uncontrolled if printed, please refer to the Maritime New Zealand website for the latest version. About this form Use