Division Page 2

On … a failure to pay a road fee with the vehicle with registration

[date]

number … make … model …

was detected by …

[name of the responsible body]

[Option 1] (¹)

You are registered as the holder of the registration certificate of the abovementioned vehicle.

[Option 2] (¹)

The holder of the registration certificate of the abovementioned vehicle indicated that you were driving that vehicle when the failure to pay a road fee was committed.

The relevant details of the failure to pay a road fee are described on page 3 below.

The amount of the financial penalty due for the failure to pay a road fee is … EUR/national currency. (¹)

The amount of the road fee due to pay is … EUR/national currency. (¹)

Deadline for the payment is …

You are advised to complete the attached reply form (page 4) and send it to the address shown, if you do not pay this financial penalty (¹)/road fee (¹).

This letter shall be processed in accordance with the national law of …

[name of the Member State in whose territory there was a failure to pay a road fee].