5 GCA § 9211: Notice: Content.

The notice served with the accusation informing respondent of an opportunity for hearing shall be substantially in the following form:

Unless a written request for a hearing signed by or on behalf

of the person named as respondent in the accompanying

accusation is delivered or mailed to the agency within fifteen

(15) days after the accusation was personally served on you

or mailed to you, (here insert name of agency) may proceed

upon the accusation without a hearing. The request for

hearing may be made by delivering or mailing the enclosed

form entitled ‘Notice of Defense,’ or by delivering or

mailing a notice of defense as provided in § 9205 to: (insert

here name and address of agency).