Prescribed Form 13

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Member Details

If Applicable
A copy of your submission will be emailed to this address.

Decision of the Member of Appeals Committee

DD slash MM slash YYYY
Enter the date of decision made by the DC in respect of your challenge.
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Max. file size: 15 MB.
    Please submit a copy of the Decision of the Members Appeals Committee and of the decision at first instance (if applicable).

    Evidence that the matter has proceeded in accordance with and exhausted the Member's own disciplinary/grievance rules and regulations.

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      Member's constitution

      Max. file size: 15 MB.

      Member's disciplinary/grievance rules and regulations

      Max. file size: 15 MB.

      Supporting material and additional evidence

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      Max. file size: 15 MB.

        Written submissions the party intends to rely on

        Max. file size: 15 MB.


        Do You Wish To Be Represented By a Support Person of the Club?*
        Do You Wish To Be Represented By a Lawyer?*


        Does the Appeals Tribunal Have Jurisdiction to Hear This Matter?*
        The jurisdiction of the Appeals Tribunal is set out in section 10 of the Football NSW Grievance and Disciplinary Regulations (Regulations). The Appeals Tribunal will only hear a matter if it has exhausted the Association Member’s own grievance or disciplinary rules and regulations (see section 10.6 and 10.3 of the Regulations).
        Please State the Grounds You Wish to Rely On
        You must select at least one of the grounds listed in section 10.3 of the Regulations.
        You must select at least one of the grounds listed in section 10.3 of the Regulations.
        COMPULSORY: Documentation to demonstrate that the matter has been exhausted in accordance with the member’s Association’s own Disciplinary Rules and Regulations must be provided.

        Affected Party

        Is There Another Party Potentially Directly Affected by your Appeal?*

        Relief Sought


        1. Please submit this form within 7 working days of the issuance of the decision of the Associations Appeals Committee.

        2. Please lodge a fee of $500 together with this Notice. Payment can be made by cheque or direct debit into Football NSW’s bank account. Bank: National Aust Bank Ltd, Account Name: Football NSW Limited, BSB: 082-356, Account Number: 14-055-1058. Please file receipt of payment into this account with the Tribunal Administrator at

        3. Participants should read and consider sections 9, 10 and 13 of the Regulations prior to signing and lodging this Notice to Football NSW.

        4. If Football NSW does not receive a properly completed Notice by the time specified in paragraph 1 together with the $500 fee, you are deemed to have waived your right to appeal the decision to the Appeals Tribunal.

        5. Capitalised words used in this document are defined in the Regulations.

        6. Where the documents to be provided exceed fifty (50) pages in total, the Member must deliver to the offices of Football NSW four (4) hard copies of those documents by the date prescribed therein.


        Digital Signature*
        By checking this box you are providing your digital signiture
        Your Name