<p> Request for a letter Warning of a Penalty Notice (Lates – U Codes) School Name:</p><p>Pupil Details: Year group: Date of Birth: Name</p><p>Address</p><p>Telephone numbers: home mobile DETAILS OF PERSONS TO BE ISSUED WITH A PENALTY NOTICE (this may be natural parents, step-parents or partners who have day to day care) Parent/Carer details (1): Mr, Mrs, Miss, Ms (please delete as appropriate) Name (in full) Relationship to pupil: Day to day care (Y/N): Address (if different to above)</p><p>Telephone numbers: home mobile work Parent/Carer details (2): Mr, Mrs, Miss, Ms (please delete as appropriate) Name (in full) Relationship to pupil: Day to day care (Y/N): Address (if different to above)</p><p>Telephone numbers: home mobile work ADDITIONAL INFORMATION - Please include details of how the parent was informed about the possibility of receiving a penalty notice and any other correspondence regarding the absences, including dates. Please attach notes of all relevant meetings with parents (e.g. School Attendance Meetings/ Team around the Child meetings) and copies of correspondence informing the parents that a penalty notice may be requested.</p><p>Declaration: I confirm that the details NB. Please include a signed attendance certificate with contained on this form are true to the this form. This form and other information will be used as best of my knowledge and belief. evidence should the case proceed to Magistrate’s Court. Signed (Headteacher): Please print name: Date:</p><p>Please send the completed form and supporting information to Amanda Lowe, Patchway Locality Hub, PO Box 298, Civic Centre, High Street, Kingswood, Bristol, BS15 0DQ</p><p>For schools using a southglos.gov.uk email address, please email: [email protected] For schools not using a southglos.gov.uk email address, please email: [email protected] ……………………………………………….</p><p>Information overleaf reviewed, agreed Please print name: Date and signed by Senior Education Officer on behalf of Team leader, Attendance, Licensing and Exclusions, ELS Divison.</p><p>………………………………………………</p><p>For Business Support Use (Kingswood Hub) use</p><p>Information sent Date By whom Response (incl. date) School letter Warning of issue letter: </p><p>Penalty Notice: </p><p>Reminder letter </p><p>Fine paid?</p><p>Further Action:</p><p>Fine paid but further unauthorised absence: Details:</p><p>Fine not paid – legal file to be prepared for prosecution: File to Court Officer: Court dates:</p><p>Outcome:</p><p>Revised July 2015 Return completed form to Amanda Lowe, Patchway Locality Hub, PO Box 298, Civic Centre, High Street, Kingswood, Bristol, BS15 0DQ</p><p>- 2 - Request for a Penalty Notice Warning Letter (Lates – U Codes)</p>