Prescribed Form 06 Prescribed Form 06 – Written Statement by a Club -Mistaken Identity in a Match Official Send-Off Report (Section 7.3) PLEASE NOTE: Unless a Team Official has indicated on the team sheet that a Participant has been mistakenly identified, the challenge will not be accepted (see section 7.3(a) and (b))Club Official's DetailsFull Name* First Last FFA Number*Club Name*Role / Position at Club*Football ManagerFootball DirectorPresidentVice PresidentSecretaryHead CoachCoachManagerClub ContactSenior ContactYouth ContactGeneral ManagerTechnical DirectorSubmission1. I am authorised to make this statement on behalf of the Club. 2. I declare that there has been a case of mistaken identity in relation to the following Fixture:Match DetailsOpposition Team*League*Example: National Premier Leagues NSW Men'sGrade*Example: National Premier Leagues NSW Men's = 1stDate of Kick-Off* Date Format: DD slash MM slash YYYY Time of Kick-Off* : HH MM AM PM 3. I declare that the Participant referred to below was not responsible for the Red Card Offence issued by a Match Official during the Fixture.Participant 's Name First Last FFA Number4. I declare that the Participant referred to below was instead responsible for the Red Card Offence issued by a Match Official during the Fixture.Participant 's Name First Last FFA Number5. I declare that the information in this statement is accurate and to the best of my knowledge. 6. I acknowledge that the Club and I may be charged with Misconduct if it is established that contents of this statement are incorrect and amount to an abuse of process.Notes: 1. Please submit this form by 4pm the next working day after the completion of the match. 2. Participants MUST submit Prescribed Form 04 at the same time as submitting this Form. 3. Clubs should read and consider section 7.3 prior to signing and lodging this form with Football NSW. 4. If Football NSW does not receive properly completed forms by the time specified in paragraph 1, the Participant issued with the Notice of Suspension shall serve the Suspension. 5. Capitalised words used in this document are defined in the Regulations.Submitter DetailsYour Name* First Last Your Email* Digital Signature*I certify that the information entered above is true and correct and was entered by myself Δ