Prescribed Form 12 – Request for General Purposes Tribunal Hearing

Applicant Details

Respondent Details


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

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: 306-089 A/C: 2766668. Use “Name & General Purpose Tribunal” as the payment reference.
Max. file size: 128 MB.


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)