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Home / Prescribed Form 10

Prescribed Form 10

"*" indicates required fields

Name*

First Last

FFA Number*

Club Name*

Notice Details

Date of Notice of Charge*

DD slash MM slash YYYY

Reference Number (e.g. GPT 16-01)*

PLEA ENTRY
Any Member issued with a Notice of Charge by Football NSW must submit a completed and signed Notice of Response by the date and time specified in the Notice of Charge.

Unless Football NSW has indicated in the Notice of Charge that the matter is to be referred directly to the GPT for hearing, the Member must indicate in the Notice of Response whether they elect to:
i. accept the charge(s) and/or penalties proposed (if any); or
ii. refer the matter to the GPT for a hearing.

If a Member elects to refer the matter to the GPT for a hearing, the Member must, by the date and time specified in the Notice of Charge:
i. pay to Football NSW the relevant Application Fee (not applicable on direct referral by Football NSW but costs may still apply);
ii. complete and submit this Notice of Response (Prescribed Form 10);
iii. submit to Football NSW all supporting material, including any additional evidence; and
iv. submit to Football NSW any written submissions the Member intends to rely on.

If Football NSW has indicated in the Notice of Charge that the matter is to be referred directly to the GPT for hearing, the Member must, by the date and time specified in the Notice of Charge:
i. complete and submit this Notice of Response (Prescribed Form 10);
ii. submit to Football NSW all supporting material, including any additional evidence; and
iii. submit to Football NSW any written submissions the Member intends to rely on.

Number of Charges*

Charge 1*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 2*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 3*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 4*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 5*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 6*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

Charge 7*

I accept the charge and the proposed sanction and acknowledge that by doing so, I forfeit my right to appeal

I do not accept the charge and plead not guilty

I accept the charge and plead guilty but wish to challenge the proposed sanction

I accept the charge and plead guilty but dispute some or all of the facts and/or the sanction

I accept one of the alternative charges (please type the alternative charge in the text box below)

Please type the alternative charge in the text box below

If you have chosen to refer this matter for hearing, please upload the following: - all supporting material, including any additional evidence, you intend to rely on; - written statements from any witnesses you intend to rely on; and - any written submissions you intend to rely on. If you have accepted the charge(s) and proposed sanction(s), you do not need to upload any documents. (Please note, the maximum size for each file is 14.7 MB)

Drop files here or

Max. file size: 18 MB.

REPRESENTATION
If you are under the age of 18, you must be accompanied at the hearing by your parent/guardian or, if you are a Match Official, by a representative from your Referees Body. If you are 18 years and over, you may have a support person present with you at the hearing. The support person can be a representative from your club (e.g. a Coach, Team Manager, MPIO etc.), parent, guardian or friend. The support person cannot be a witness in the matter.

Will you have a parent, guardian or support person present with you for the hearing?*

Yes

Please provide the name and contact details of that person.

Name

First Last

Phone

Will you be submitting an application to be legally represented at the hearing?*

Yes

Please provide the name and contact details of that person.

Name

First Last

Phone

Please upload your submissions indicating why you should be granted leave to be legally represented.

Drop files here or

Max. file size: 18 MB.

Do you wish for the Match Official/s to attend the hearing for cross-examination?*

Yes

Please state which Match Official you require to attend the hearing for cross examination below:

Name

First Last

Do you wish for any of the Football NSW witnesses to attend the hearing for cross examination?*

Yes

Please list the names of each witness required below:

Please list below the names of all witnesses for whom you have provided statements for:

NOTE: Witnesses must attend the hearing unless advised otherwise by Football NSW. Their failure to attend may result in the GPT attaching less weight to their evidence or result in their evidence being excluded entirely.

Notes:
1. Please submit this form by the date referred to in the Notice of Charge.
2. Unless there is a reasonable excuse, if Football NSW does not receive a properly completed Notice of Response by the time specified in paragraph 1 above, you are deemed to have pleaded guilty to the charge(s) set out in the Notice of Charge, accept the reports attached to the Notice of Charge (section 9.2(k)).
3. Participants should read and consider section 9.2 (Charges of Misconduct and Disrepute) and section 13 (Administrative Procedures of Tribunals) prior to submitting this Notice of Response to Football NSW.
4. Capitalised words used in this document are defined in the Regulations.

Submission

Your Name*

First Last

Your Contact Email*

Digital Signature*

I certify that the information entered above is true and correct and was entered by myself.

By checking this box you are giving your digital signature

Submission Date*

DD slash MM slash YYYY

02 8814 4400 reception@footballnsw.com.au Mon - Fri, 9am - 5pm

Valentine Sports Park
235 - 257 Meurants Lane
Glenwood NSW 2768

PO Box 6146
Baulkham Hills BC NSW 2153

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