Reimbursement Claim-Match fees

Reimbursement Claim Form
Unpaid Match Official Fees
The following form is for match officials to claim unpaid match official payments.

Please fill in all fields and provide as much information as possible to validate your claim.
Submitted By (full name)*
Email*
FFA ID Number*
Reimbursment Details
Reason for claim*

Teams have not shown on match dayHome club has not paid fee on match dayFV NTC Boys/ Girls TeamSAP Gala DayOther
Detailed explanation of claim*
Match Details
Appointment Type*
Competition *
Competition Grading*
Home Team*
Away Team*
Date*

DayMonthYear
Kick Off Time*

Hour Minutes

AM/PM Option
Venue*
Any other comments if appropriate
I declare that the information provided is true and accurate and understand that false or misleading information will be subject to penalty.*

I agree
Football Victoria (FV) Inc

Privacy Collection Notice

In this form, you are asked to provide Football Victoria (FV) Inc ABN 97 592 993 965 (‘FV’) with personal information (which may include sensitive information). FV regards the management of personal information in an open and transparent way as a priority.  FV collects personal information (including through Football Australia’s (‘FA’s’) MyFootballClub Customer Relationship Management System (‘MyFootballClub’)) for various reasons, including:

·  for the organisation, conduct and promotion of football competitions, matches, programs and products and related objects set out in FV’s constitution;

·  to process registration of individuals to participate in football competitions, matches, programs and products, as a player, official or otherwise;

· to identify, create and provide services and benefits, some of which may be provided by or in conjunction with FA, government agencies or other FV partners or affiliated or associated entities, or through FV’s Football Fives website;

·   to communicate with you and other stake-holders to provide football related information and offers from football administrators or other FV partners (both commercial and not-for-profit);

·   to maintain participation and service/benefit records, data and statistics, including for archive and historical purposes;

·    to identify, create and provide services to registered participants, officials, clubs, club members, zones, supporters, students, and members of the public, which may occasionally warrant direct marketing of these services (unless you opt out of any such direct marketing);

·    to satisfy its obligations and comply with applicable statutes, regulations and policies as a Member Federation of FA and the international governing body FIFA;

·    in relevant cases, and with your consent where the information is sensitive information, for research and/or review, including for the purposes of assessing performance, health or injury including in FV and FA’s (Victorian) talented player programs, to research participation in football or target funding; and

·     to satisfy its obligations under the Associations Incorporation Act 1981 (Vic) and otherwise at law.

Further information about accessing and correcting your details or making a complaint are available in FV’s Privacy Policy. By completing and submitting his form, you consent to the collection, use and disclosure of your personal information as described above and as set out in FV’s Privacy Policy.
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