Prescribed Form 15 – Request for Appeal Tribunal Hearing

Charged Party

Fixture Details

DD slash MM slash YYYY

Offence(s) Being Challenged

Grounds of Appeal(Required)

Contact Details for Tribunal Hearing


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

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

Payment of the Tribunal Fee

Payment is to be made directly into Football West’s bank account: BSB: 306-089 A/C: 2766668. Use “Club Name & Appeal Tribunal” as the payment reference. Tribunal Fees: Senior NPL and State League – $880; All other leagues – $660; Match Official – $330; Individual – $330
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 charged party is not an associate of any club; or c) if it bears the name and signature of the President or Secretary below.
Lodged By(Required)