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Request an Extension to Screen a Penalty Notice

Please complete the form below to apply for an "Extension of Time to Request a Screening" of your Penalty Notice. Once received, the Screening Officer will determine if the grounds for the extension of time are approved. You will receive an email response within 5 business days advising you of the outcome of your request.

Are you the registered owner of the vehicle or do you have their permission to submit on their behalf?
 
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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Collection of Personal Information

Personal information contained on this form is collected pursuant to the Municipal Act, 2001, s. 11(1), and will be used for the purpose of making a determination regarding the consideration of granting an "Extension of Time to Request a Screening". Questions about this collection should be directed to the Records & Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9 or 905-619-2529 ext. 3343

Accessibility

This form is available in alternate formats, upon request, by contacting 905-619-2529 ext. 3347, or email accessibility@ajax.ca