Prescribed Form 13 Notice of Appeal of a Decision of a Member Appeals Committee Notice of Appeal of a Decision of a Member Appeals Committee Prescribed Form 13 Member DetailsMember*FFA NumberIf ApplicableYour Email Address* A copy of your submission will be emailed to this address.Decision of the Member of Appeals CommitteeDate of Member Appeals Committee's Decision* Date Format: DD slash MM slash YYYY Enter the date of decision made by the DC in respect of your challenge.Copy of the Decision of the Member Appeals Committee* Drop files here or 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.Please submit documentation and evidence that the matter has proceeded in accordance with and exhausted the Member's own disciplinary/grievance rules and regulations.* Drop files here or Member's constitutionPlease submit a copy of the Member's constitution.*Member's disciplinary/grievance rules and regulationsPlease submit a copy of the Member's disciplinary/grievance rules and regulations.*Supporting material and additional evidencePlease submit any supporting material and additional evidence.* Drop files here or Written submissions the party intends to rely onPlease submit written submissions the party intends to rely on.*RepresentationDo You Wish To Be Represented By a Support Person of the Club?* Yes No Do You Wish To Be Represented By a Lawyer?* Yes No JurisdictionDoes the Appeals Tribunal Have Jurisdiction to Hear This Matter?* Yes No 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 A party was not afforded a reasonable opportunity to present its case Lack or excess of jurisdiction of a Body or a Member Appeals Committee The decision of a Body or a Member Appeals Committee was affected by actual bias The decision was one that was not reasonably open to a Body or a Member Appeals Committee having regard to the evidence before the Body or the Member Appeals Committee Severity, only where the decision of a Body or a Member Appeals Committee 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 v) a deduction, loss or ban on accruing six (6) or more competition points; or vi) exclusion, suspension or expulsion of a Club or Team from a competition; or. vii) relegation to a lower division; or leniency, but only in the case of an appeal brought by Football NSW or an appeal allowed by the Executive pursuant to section 10.2 (g) (Appeal from a Member Appeals Committee). You must select at least one of the grounds listed in section 10.3 of the Regulations.Please provide relevant facts and legal arguments that relate to each of the grounds of appeal that you wish to rely on.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 PartyIs There Another Party Potentially Directly Affected by your Appeal?*YesNoRelief SoughtPlease 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 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 tribunal@footballnsw.com.au. 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.SubmissionDigital Signature* I certify that the information entered above is true and correct and was entered by myself. By checking this box you are providing your digital signitureYour Name First Last Δ