■ 출입국관리법시행규칙 [별지 제141호서식] <개정 2018. 6. 12.>

통 고 서 (WRITTEN NOTIFICATION)

수신 :

To

인적사항

(Person to

whom the

Notification

relates)

성명 (Full name)

생년월일 (Date of Birth)

국적 (Nationality)

성별 (Sex)  남 Male[ ] 여 Female[ ]

직업 (Occupation)

연락처(Phone No.)

대한민국 내 주소 (Address in Korea)

위반사실

(Offense

charged)

적용 법조문

(Applicable

provision)

범칙금액

(Monetary penalty)

원 (\)

납부기한

(Deadline for

penalty)

0000. 00. 00. 까지

납부장소

(Place of

payment)

국고수납기관

(National fund receipt agency)

위 사람에 대한 「출입국관리법」 위반 용의사건을 조사한바, 용의자는 「출입국관리법」 제    조를 위반하였음이 명백하므로 같은 법 제102조에 따라 위 범칙금액을 위 납부기한까지 국고수납기관에 납부할 것을 통고합니다. 위 기한 내에 납부하지 아니할 때에는 「출입국관리법」 제105조에 따라 관할 검찰청에 고발합니다.

Based on the results of our investigation into the alleged violation of the Immigration Act, as well as the statements made by the abovementioned person and persons concerned, the abovementioned person is found to have violated Article      of the Immigration Act. It is hereby notified that the person is required to pay the amount of penalty to the national fund receipt agency no later than the deadline as specified above, in accordance with Article 102 of the Immigration Act.

Failure to pay the penalty within the deadline will result in a complaint being filed with the district public prosecutor’s office in accordance with Article 105 of the Immigration Act.

년       월      일

Date         (year)    (month)    (day)

○○출입국ㆍ외국인청(사무소ㆍ출장소)장	직인

CHIEF, ○○IMMIGRATION OFFICE

210mm×297mm[백상지 80g/㎡(재활용품)]