| Party subject to Penalty Person(s) | Natural Person | Name | Sex | |||
|---|---|---|---|---|---|---|
| Date of birth | Personal identification document number | |||||
| Address | ||||||
| Other identifying characteristics | ||||||
| Statutory Responsible Persons, Non-juridical Person Group, Central or Local Authorities or Other Organizations | Name | |||||
| Address | ||||||
| Statutory Responsible Person (Manager or Representative) | Name | Sex | ||||
| Date of birth | Personal identification document number | |||||
| Address | ||||||
| Time of violation | AM/PM | |||||
| Nature of Violation | ||||||
| Location of Violation | ||||||
| Disciplinary Action |
|
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| Reason for Disciplinary Action and Legal Basis | Violation of , , of the Marine Pollution Control Act; penalized pursuant to , , of the same Act. |
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| Payment deadline | Before | |||||
| Payment location | ||||||
| Please note |
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This disciplinary citation consists of three copies; the first copy is kept for reference, the second copy is given to the recipient of the citation, and the third copy is given to administrative departments under the Ministry of Justice Administrative Enforcement Agency for processing.