Home / Prescribed Form 12

Prescribed Form 12

Section 9.6

"*" indicates required fields

Member Details

Full Name*

Decision of General Purposes Tribunal

DD slash MM slash YYYY
Max. file size: 15 MB.
Please attach a copy of the decision of the GPT with this Notice

Supporting material and additional evidence

Drop files here or
Max. file size: 15 MB.
    Please attach all supporting material, including any additional evidence

    Written submissions the Member intends to rely on

    Drop files here or
    Max. file size: 15 MB.
      Please attach written submissions the Member intends to rely on.

      Representation

      Do you wish to be represented by a support person of the Club?*
      Do you wish to be represented by a lawyer?*

      Jurisdiction

      Does the Appeals Tribunal have jurisdiction to hear this matter?*
      The 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.*
      You must select at least one of the grounds listed in section 10.2 of the Regulations.

      Affected Party

      Is there another party potentially directly affected by your appeal?*

      Relief Sought

      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 tribunal@footballnsw.com.au.

      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.

      Submission

      Your Name*
      Digital Signature*