2 Omit this paragraph if it does not apply.
[Full name, address, telephone number(s), date of birth] (the substitute) was served with a written caution on [date] that a motor vehicle belonging to the substitute could be seized if the defendant defaults in paying another fine for a traffic offence committed using a motor vehicle belonging to the substitute.
The amount of overdue fines arising out of the defendant's use of the substitute’s motor vehicle(s), excluding seizure costs, is: $[amount].
Unless those fines are paid, you are authorised to seize any motor vehicle that apparently belongs to the substitute. This includes any motor vehicle that is jointly owned by the substitute and another person or persons.