Prescribed Form 09 – Notice of Appeal Prescribed Form 09 – Notice of Appeal – Decision of the Disciplinary Committee (Red Card Offences) Member DetailsFull Name* First Last FFA Cup*Club Name*Your Email* Decision of the Disciplinary CommitteeDate of Notice of Suspension* Date Format: DD slash MM slash YYYY Date of Decision in Respect of Your Challenge* Date Format: DD slash MM slash YYYY Copy of Notice of Suspension*Copy of decision regarding your challenge*JurisdictionDoes the Appeals Tribunal have jurisdiction to hear this matter?YesNoThe jurisdiction of the Appeals Tribunal is set out in section 10.1 of the Football NSW Grievance and Disciplinary Regulations (Regulations). The Appeals Tribunal will only hear an appeal iif it relates to a decision that was made by the Disciplinary Committee pursuant to section 8.3 of the Regulations (appealing a decision of the DC (Red Card Offences)). Further, the Participant must satisfy one or more grounds of appeal set out in section 10.2 of the Regulations.Please state the grounds you wish to rely on A party was not afforded a reasonable opportunity to present its case Lack or excess of jurisdiction The decision of the Body was affected by actual bias The decision was one that was not reasonably open to the Body having regard to the evidence before the Body Severity, only where the decision of the Body imposed a sanction of at least: i) A Fixture Suspension of six (6) or more Fixtures; or ii) A Time Suspension of three (3) or more months; or iii) A fine of three thousand dollars ($3000) or more; or iv) A loss of six (6) or more competition points; or v) Expulsion from a competition. Please provide relevant facts and legal arguments that relate to each of the grounds of appeal that you wish to rely on.*Affected PartyPlease provide relevant facts and legal arguments that relate to each of the grounds of appeal that you wish to rely on.*YesNoPlease describe the relief that you are seeking*Notes: 1. Please submit this form within 7 working days of the issuance of the decision of the DC to the Club by Football NSW. 2. Please lodge a fee of $750 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 tribunal@footballnsw.com.au. 3. Participants should read and consider sections 8, 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 $750 fee, you are deemed to have waived your right to appeal the decision of the DC. 5. Capitalised words used in this document are defined in the Regulations.SubmissionYour name* First Last Digital Signature*I certify that the information entered above is true and correct and was entered myself Δ