Certificate issued pursuant to section 7.92 of the Aeronautics Act

In the matter of the contravention of by

(specify designated provision)(identify contravener)

Having reviewed the materials submitted by the Minister and having verified that no request for a review was filed with the Tribunal, it is hereby certified that:

a monetary penalty in the amount of $ was assessed by way of notice:

(specify amount)

(tick the correct box)

☐ served on by personal service on , or

(identify contravener)(specify date)

☐ sent to by registered or certified mail on ;

(identify contravener)(specify date)

failed to pay the amount of the monetary penalty

(identify contravener)

and did not file a request for review within the time specified in the notice, being on or before

; and

(specify date)(identify contravener)

is deemed to have committed the contravention alleged in the notice, and the amount of specified in the

(specify amount)

notice is outstanding.

Dated this day of , 20

Signed by:

Name of Chairperson or Vice-chairperson of Tribunal

Address of Tribunal