1. Please submit this form by 4pm the next working day after the completion of the match.
2. In addition to submitting this form, please submit one of the following forms at the same time:
a. Prescribed Form 05 by the Participant actually responsible for the Offence9
Prescribed Form 06 by your Club identifying the Participant responsible for the Offence;
b. Any other evidence which may support your challenge.
3. Participants should read and consider section 7.3 prior to signing and lodging this form to Football NSW.
4. If Football NSW does not receive a properly completed forms by the time specified in Note 1, you are deemed to have committed the Offence and will be issued with a Notice of Suspension.
5. Capitalised words used in this form are defined in the Regulations.