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Prescribed Form 07

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Your Details

Full Name*

Match Details

Example: National Premier Leagues NSW Men's
Example: National Premier Leagues NSW Men's = 1st
DD slash MM slash YYYY
Time of Kick-Off*
:

Submission

  • 1. I declare that the following Participant of my Club was responsible for the Offence and the Suspension issued against me should be transferred across to the Participant mentioned below:
    • Participant 's Name*
  • 2. I declare that the information in this statement is accurate and to the best of my knowledge.
  • 3. I acknowledge that I may be charged with Misconduct if it is established that the contents of this statement are incorrect and amount to an abuse of process.
    • Notes:
  • 1. Please submit this form within (7) working day after the issuance of Football NSW's decision
  • 2. In addition to submitting this form, please submit the following documents at the same time:
  • a. pay to Football NSW the application fee of $500; and
  • b. Any other evidence which may support your challenge.
  • c. any written submissions you intend to rely on.
  • 3. Participants should read and consider section 7.4 prior to signing and lodging this form with the Appeals Tribunal.
  • 4. If Football NSW does not receive properly completed forms by the time specified in paragraph 1, you are deemed to have committed the Offence and will be issued with a Notice of Suspension.
  • 5. Capitalised words used in this document are defined in the Regulations.
    • Max. file size: 15 MB.

    Submitter Details

    Your Name*
    Digital Signature*