ROINN BITHRE AGUS TRCHTA

ROADS & TRAFFIC DEPARTMENT

Achomhairc um an tSeirbhs Clampaithe
Agus Tarlaithe

Clamping and TowAway Service Appeals


Ms mian leat achomharc a dhanamh, comhlnaigh agus seol
Ar ais an fhoirm seo chuig:
If you wish to make an appeal please complete this form and return
it to:


Roinn Bithre agus Trchta Roads & Traffic Department
Ranng na nAchomharc Appeals Section
Oifig na Cathrach Civic Offices
An Ch Adhmaid, B..C. 8 Wood Quay, Dublin 8


T. 01 222 2261 F. 01 222 0621 E. parkingenforcement@dublincity.ie

Iarratas Achomhairc um Chlamp / Tharl
Clamping / Tow-Away Appeal Application



(SCROBH I mBLOCLITREACHA, LE DO THOIL)
(PLEASE WRITE IN BLOCK PRINT)



Ainm
Name



Seoladh
Address








Uimhir an Fhgra Notice Number: (This
(Seo uimhir an is the number of the
ticid um chlamp / clamping / tow-away
tharl a fuair t) ticket you received)


Dta an Clruimhir na
Ticid: Feithicle:
Date of Ticket: Vehicle Registration

Number:




An suomh inar
Pirceladh an
Fheithicil:

Location where
vehicle was parked:
Cinel Achomhairc/Ghearin:
Nature of Appeal/Complaint:
































Liosta doicimad faoi iamh:
List of enclosed documentation:

















Sni ____________________________ Dta___________________
Signature Date