Region of Waterloo Form

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Required fields are marked with asterisks (*)

Provincial Offences Court

Postponement of Early Resolution Appointment

Request for postponement of Early Resolution Appointment to be completed and submitted to the Clerk of the Court no later than 2 business days before the currently scheduled meeting time. You are entitled to reschedule once. The court will reschedule the date which cannot exceed 30 days from the originally scheduled meeting time.

Ticket/File Number (ex: 4460 1234567F or 4460 999 00 5861234Z 00)

Do you have more than one ticket?

Yes

First Name

Last Name

Address

Unit Number

City/Township

Postal/Zip Code

Phone Number

Email Address

Current Appointment Date

Do you require an interpreter?

Yes

Special Instructions

Submitted By

Date

*Note: If you or your representative does not attend this joint appearance, you will be deemed to not wish to dispute the charge(s). In your absence you may be convicted as originally charged including the original penalty, plus costs.