Required fields are marked with asterisks (*)

Request a Screening Review

If you have received a penalty notice (ticket) and are still within the allowed dispute period (15 days for parking violations or 30 days for non-parking violations from the date of issuance), you can request a review by a Screening Officer.

After your request is submitted, a Screening Officer will schedule a review to take place by phone or email during business hours (8:30 a.m. to 4:30 p.m., excluding weekends and statutory holidays). You will be notified of the decision in writing once the review is complete.

For more information about the Administrative Penalty System, or to obtain an Authorization to Act as Agent form or an Extension Request Form, please visit www.cambridge.ca/tickets

Applicants are responsible for the completion and accuracy of this form.

First Name

Last Name

Phone

Example: 519-555-1234

Preferred Contact Method

Phone

Both

House Number

Street Name

Unit Number

City

Postal Code

Example (Canada): N1R 5S5

Penalty Notice Number

Penalty Issue Date

Is this a parking ticket?

Yes

Licence Plate

I have attachments to include

Upload supporting documents or images:

Single file size limit: 15MB (For files over 15 MB, email them to tickets@cambridge.ca.)

Reason for Review

0 / 4000

Accessibility Accommodation

Accessibility Required

The City of Cambridge is committed to providing accessible and inclusive services and facilities as required in the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act. If you require an accommodation to be able to fully participate in any part of the screening process, please contact us by email at accessibility@cambridge.ca

Statement of Penalty Notice Recipient

I represent and warrant that:

I am either the registered owner of the vehicle associated with the parking ticket, the individual named on the penalty notice for a non-parking offence, or an authorized representative of the accused (Authorization to Act as Agent Form required)

I acknowledge that if I or my authorized representative fail to appear and to remain at a scheduled screening until my matter has been determined by the screening Officer, I will be deemed to have abandoned my request for a screening, The Penalty Notice will be affirmed, and I will be liable for any additional administrative fees and a $25 no-show fee

I have read and understood the conditions of this application

Signature Name

Signature Date

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act. Personal information will only be kept for as long as necessary to fulfill the purposes for which it is collected. If you have any questions about this collection of personal information, you can contact the Manager of Municipal By-law Compliance and Corporate Security at bylaw@cambridge.ca