Request for General Purposes Tribunal Hearing

Applicant Details

Name(Required)

Club(Required)

Phone(Required)

Email(Required)

Respondent Details

Name(Required)

Club(Required)

Phone

Outline of Ground for Request for General Purposes Tribunal Hearing(Required)

Acknowledgment

In lodging this request, the applicant acknowledges that:(Required)

If the matter is a grievance, the parties can demonstrate that they have attempted to resolve the grievance in accordance with Article 19 of the Disciplinary & Grievance Regulations prior to lodging the request for a General Purpose Tribunal Hearing.

Payment of the Tribunal Fee must be made when submitting this form.

No request will be accepted if the applicant has a debt owing to Football West which is older than 30 days.

A request for a General Purposes Tribunal that does not meet all of the above requirements will not be accepted under any circumstances.

Payment of the Tribunal Fee

A Tribunal hearing fee of $550 is payable by the party requesting the Tribunal. Payment is to be made directly into Football West’s bank account: BSB: 066 000 A/C: 17153539. Use “Name & General Purpose Tribunal” as the payment reference.

Please upload proof of payment(Required)

Max. file size: 128 MB.

Lodgement

This form must be lodged by either the President or Secretary of the club. A form lodged by any other person will not be accepted unless: a) the club can demonstrate exceptional circumstances exist and approval has been received in writing by Football West. b) the applicant is an associate of a club which they have the Grievance with. or c) if it bears the name and signature of the President or Secretary below.

Lodged By(Required)

President

Secretary

Individual

Name(Required)

Signature(Required)