Prescribed Form 15 – Request for Appeal Tribunal Hearing Charged PartyName(Required)Club(Required)FFA Number(Required)Fixture DetailsDate(Required) DD slash MM slash YYYY Time(Required) Hours : Minutes AM PM AM/PM Clubs(Required)Competition(Required)Grade/Age(Required)Offence(s) Being ChallengedOffence Description(Required)Grounds of Appeal(Required) A party was not afforded a reasonable opportunity to be heard; or The determination was affected by bias; or The decision was one that was not reasonably open to the Tribunal having regard to the evidence before that Tribunal. Statement outlining your grounds of appeal(Required)Contact Details for Tribunal HearingName(Required)Phone(Required)Email(Required) AcknowledgmentIn lodging this request, the Club acknowledges that:(Required) A request for an Appeal Tribunal hearing must be lodged within 5 Business Days of Football West issuing the Club the decision of the Disciplinary or General Purposes Tribunal. Payment of the Tribunal fee ($880 for Senior NPL and State League, $660 for other leagues) must be made when submitting the request for a hearing. The Tribunal fee will only be refunded if the appellant is found not guilty or if a refund is otherwise ordered by the Appeal Tribunal. No request will be accepted if the club has a debt owing to Football West which is older than 30 days. Where an Appeal Tribunal fully or partially reverses or overturns the decision of a Disciplinary Tribunal or General Purposes Tribunal, no refund of the original Tribunal hearing fee is refunded to the party except the Appeal Tribunal Fee. 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 FeePayment is to be made directly into Football West’s bank account: BSB: 066 000 A/C: 17153539. 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 Please upload proof of payment(Required)Max. file size: 128 MB.LodgementThis 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) President Secretary Individual Name(Required)Signature(Required)
