(1) in the page header, the following particulars:(a) the number of the statement of offence;
(b) the name of the judicial district;
(c) (subparagraph revoked);
(d) the vehicle’s registration number or, where applicable, the temporary registration certificate number, and the province, territory or state that issued the registration, as well as the make and model of the vehicle;
(e) the date on which the offence was committed;
(f) the request for sentence; and
(g) the date and time of service of the statement of offence; and
(2) in the section concerning the plea and payment:(a) the defendant’s plea of guilty;
(b) the defendant’s signature or, as the case may be, his signature affixed electronically or the validation code for his signature so affixed, the date of the signature and the quality of the signatory if the defendant is a legal person;
(c) the place where the defendant must transmit the plea or the place where payment must be made and the deadline by which the plea must be transmitted and the payment made;
(d) the consequences of paying the total amount of the fine, the costs and, where applicable, the contribution; and
(e) the sum actually paid.