HSA 010 - Disciplinary Appeal

Disciplinary Appeal

HSA 010
* This appeal must be lodged within seven (7) days of the date of the determination *

* An appeal fee of $250 must be lodged with this form *
Charged Party
Name*
Club*
Email*
example@example.com
Details of Determination
Date of Determination *
Offence*
Penalty applied*
Grounds for the Appeal*

Failure to afford procedural fairnessLack of jurisdictionInsufficient evidenceIncorrect interpretation of the By-LawsInvolves a question or principle of importance to Football NSWSeverity
Reason for the Grounds of Appeal*
Submitted by*

First NameLast Name
Club Position*
Email*
example@example.com
Phone*

My Products*

Total $0.00AUD

Disciplinary Appeal