28. The back of the pages or the data on the corresponding page screens in the statement of offence shall contain at least the headings, key words, texts and spaces allowing the following to be entered:(1) a description of the general purpose of a statement of offence;
(2) a description of the procedural steps entailed either by transmitting or failing to transmit a plea or by indicating an intent to contest the greater sentence requested;
(3) the place where the defendant must transmit the plea and, in the case of a plea of guilty, the place where he must transmit the total amount of the fine, the costs and, where applicable, the contribution, or the notice of his intent to contest the greater sentence requested;
(4) the deadline by which the defendant must transmit the plea and, in the case of a plea of guilty, the deadline by which he must transmit the total amount of the fine, the costs and, where applicable, the contribution, or the notice of his intent to contest the greater sentence requested;
(5) the procedure for payment of the total amount of the fine, the costs and, where applicable, the contribution;
(6) mention of the fact that preliminary applications may be made; and
(7) the right to counsel.
The back of the pages may also contain a section for explanation of the codes and acronyms and, depending on the type of payment required in the request for sentence, may contain one or more of the following:(1) a box where a cashier’s stamp may be affixed attesting that a payment has been received;
(2) a payment receipt form;
(3) a record or an attestation of an electronic transaction; and
(4) the reference to the document attesting to the receipt of a payment.