Prescribed Form 12- Notice of Appeal of a Decision of a GPT Prescribed Form 12 - Notice of Appeal of a Decision of a GPT Section 9.6 Member DetailsFull Name* First Last FFA NumberMember*Contact Email Address* Decision of General Purposes TribunalDate of GPT Determination* Date Format: DD slash MM slash YYYY Copy of the decision of the GPT*Please attach a copy of the decision of the GPT with this NoticeSupporting material and additional evidenceSupporting material and additional evidence* Drop files here or Please attach all supporting material, including any additional evidenceWritten submissions the Member intends to rely onWritten submissions the Member intends to rely on* Drop files here or Please attach written submissions the Member intends to rely on.RepresentationDo you wish to be represented by a support person of the Club?*YesNoDo you wish to be represented by a lawyer?*YesNoJurisdictionDoes 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 a matter in the following circumstances: (a) An appeal of a decision made by the GPT pursuant to section 9.2 of the Regulations (charges of Misconduct and Disrepute); and (b) An appeal of a decision made by the GPT pursuant to section 9.3 of the Regulations (Grievances) subject to section 10.5 of the Regulations. Further, the Participant must satisfy one or more grounds of appeal set out in section 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 iv) a bond to be of good behaviour of three thousand dollars ($3000) or more v) a dedcution, loss or ban on accuring 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 Fotball NSW or an appeal allowed by the Executive pursuant to section 9.2(h) You must select at least one of the grounds listed in section 10.2 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.*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 GPT. 2. Please lodge a fee of $750 together with this Form. Payment can be made by 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 include the GPT reference number when making payment and provide proof of payment to [email protected] 3. Participants should read and consider sections 9, 10 and 13 of the Regulations prior to submitting 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 proof of payment of the $750 fee, you are deemed to have waived your right to appeal the decision of the GPT. 5. Capitalised words used in this document are defined in the Regulations. 6. Where the documents to be provided under section 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. SubmissionYour Name* First Last Digital Signature* I certify that the information entered above is true and correct and was entered by myself.